Clinical study of Neurological Manifestations in HIV

Manikandan, S (2008) Clinical study of Neurological Manifestations in HIV. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.


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INTRODUCTION : The acquired Immuno Deficiency Syndrome (AIDS) caused by a retrovirus variously termed Human Immuno Deficiency Virus – 1 (HIV-1) Human T-Lymphocytic Virus III or Lymphadenopathy associated virus is no longer a rare or exotic disease. Since its first description in June 1981 it is now a Worldwide Pandemic. In the early years of epidemic, nervous system involvement was not widely recognized. It is now recognized that were level of neuraxis can be involved and at least one third of patients with advanced HIV infection will develop neurological complications during the course of their illness and 10% of cases neurological problems may be first sign of development of AIDS. But at autopsy, more than 80% of patients show evidence of cerebral pathology ranging from HIV encephalitis, opportunistic infections or lymphomas and some evidence of peripheral neuropathy. Neurological manifestations of HIV consists of CNS complications caused directly by HIV, and include cognitive disorders and other CNS disease such as myelopathy and the demyelinating neuropathies, and the secondary disorders caused by opportunistic infections, neoplasm, cerebrovascular events, as also the effects of metabolic derangements and medications. Considering the protean manifestations of neurological illness in HIV infected, an analysis of neurological manifestations in this subset of Patients was made. AIM OF THE STUDY : To study the spectrum of neurological manifestations in HIV infected subjects at various level. To study the correlation of neurological manifestations with CD4 count in these subjects. MATERIALS AND METHODS PLACE OF THE STUDY: This study was conducted at the Government Mohan Kumaramangalam Medical College Hospital, Salem. Patients admitted to the wards of the internal medicine and Infectious Disease wards were subjects of the study. PERIOD OF STUDY: January 2006 to July 2007. DESIGN: Prospective Randomised cross sectional study. METHODOLOGY: HIV patients admitted at G.M.K.M.C. Hospital were chosen for the study. Random selection of patients were made in whom a detailed history and clinical evaluation which included the mini mental score (MMSE) was done, after an informed consent from the patient or relative. The following investigation were done to all patients studied (i.e), when tested positive for HIV. 1. Complete blood count, 2. Renal function test (Sugar, Urea, Creatinine and Electrolytes), 3. Liver Function Test (Bilirubin, AST, ALT, SAP, Albumin), 4. Chest X-ray - P.A View, 5. VCTC, 6. CD4 count, 7. VDRL. All patients with neurological systems were individualised and were subjected to the investigation listed based on clinical findings. 1. C.S.F, 2. CT Brain, 3. MRI Brain, 4. Creatinine Phosphokinase. METHODOLOGY OF INVESTIGATION: HTV testing and CD4 count were done by microbiology department in our hospital as per NACO Guidelines. CD4 count was done with Facs Count (Automated Counter). Tests were done in a single laboratory by the same person, no intrapersonal error was possible. Exclusion Criteria: Immuno Compromised state due to any other cause. Limitations : Culture and PCR for mycobacterium could not be done. Viral Serology was done only in selected patients. RESULTS : Incidence : 31 Patients had neurological manifestations among the 100 Patients studied. The incidence of neurological manifestations in HIV infection, in this study is 31%. Sex Distribution : Of the 100 Patients studied 80 were male and 20 were Female. Among the 80 males, 28 had neurological manifestations and of the 20 Females, 3 had neurological Symptoms. Majority of the patients in our study were between 31-40 yrs of age. Of the 60 Patients, who were in the age group of 31-40, 19 (31.6%) had neurological symptoms. SUMMARY : We study 100 consecutive HIV sero positive patients from January 2006 to July 2007 of them 31 had neurological manifestations. Out of which TB meningitis constituted major part. The following were the details of neurological manifestations. Tuberculous meningitis (35.4%), cerebrovascular complications (9.67%), Guillian barre syndrome (3.22%), pyogenic meningitis (6.44%), peripheral neuropathy (6.44%), seizure disorders (6.44%), acute flaccid paralysis (3.22%), AIDS dementia complex (3.22%), cerebellar syndrome (3.22%), cryptococcal meningitis (3.22%), Toxoplasmosis (3.22%), HIV myelopathy (3.22%), meningoencephalitis - cause not determined (3.22%), multiple granulomata (3.22%), myopathy (3.22%), Tuberculoma (3.22%). Mortality increased most with coexisting meningitis and with decreased CD4 counts. Commonest neurological condition associated was neurotuberculosis. CONCLUSION : 1. Incidence of neurological illness in HIV infection in our study was 31%. 2. All patients in our study had heterosexual transmission of disease. 3. CNS manifestations in men were more common than in women. 4. Headache and altered mentation were the two common symptoms observed in this study. 5. Tuberculous meningitis was the most commonest opportunistic infection in our study. 6. No significant CD4 count correlation was found between the patients with neurological manifestations and those without neurological manifestations. 7. CD4 count when less was associated with increased mortality. 8. Patients with coexisting tuberculous meningitis and HIV infection had significantly lower CD4 counts. 9. Tuberculous meningitis was associated with good outcome and pyogenic meningitis had high mortality. 10. Patients with neurological manifestations had good outcome and low mortality.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neurological Manifestations ; HIV ; Clinical study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 16 Feb 2018 16:19
Last Modified: 16 Feb 2018 16:19

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