Research Article: The pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestation in Ethiopia: a retrospective study

Date Published: April 10, 2012

Publisher: BioMed Central

Author(s): Tesfaye Berhe, Yilma Melkamu, Amanuel Amare.


Even though the prevalence of HIV infection among the adult population in Ethiopia was estimated to be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective study was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations.

Medical records of 347 patients (age ≥13 years) admitted to Tikur Anbesa Hospital from September 2002 to August 2009 were reviewed and demographic and clinical data were collected.

Data from 347 patients were analysed. The mean age was 34.6 years. The diagnosis of HIV was made before current admission in 33.7% and 15.6% were on antiretroviral therapy (ART). Causes of neurological manifestation were: cerebral toxoplasmosis (36.6%), tuberculous meningitis (22.5%), cryptococcal meningitis (22.2%) and bacterial meningitis (6.9%). HIV-encephalopathy, primary central nervous system (CNS) lymphoma and progressive multifocal leukoencephalopathy were rare in our patients. CD4 count was done in 64.6% and 89.7% had count below 200/mm3[mean = 95.8, median = 57] and 95.7% were stage IV. Neuroimaging was done in 38% and 56.8% had mass lesion. The overall mortality was 45% and the case-fatality rates were: tuberculous meningitis (53.8%), cryptococcal meningitis (48.1%), cerebral toxoplasmosiss (44.1%) and bacterial meningitis (33.3%). Change in sensorium and seizure were predictors of mortality.

CNS opportunistic infections were the major causes of neurological manifestations of HIV/AIDS and were associated with high mortality and morbidity. Almost all patients had advanced HIV disease at presentation. Early diagnosis of HIV, prophylaxis and treatment of opportunistic infections, timely ART, and improving laboratory services are recommended. Mortality was related to change in sensorium and seizure.

Partial Text

Symptomatic neurologic dysfunction develops in more than 50% of individuals infected with human immunodeficiency virus (HIV) [1] and about 10% experience neurologic symptoms as the initial manifestation of acquired immunodeficiency syndrome (AIDS) [2]. Neurologic disorders associated with HIV infection include central nervous system (CNS) infections, neoplasms, vascular complications, peripheral neuropathies and myopathies [3]. Neurologic dysfunction is an important cause or a strong marker of poor prognosis in late HIV infection [4].

In this retrospective study, HIV infected patients aged ≥ 13 years who were admitted with neurological manifestations of HIV/AIDS to TAH from September 2002 to August 2009 were included. Medical records of patients were retrieved and data sheets were used to collect the following data: age, sex, address, occupation, marital status, presenting symptoms and signs, investigations, treatment, duration of hospital stay, treatment outcome at hospital discharge.

Data from 347 patients were analysed. The mean age was 34.6 years (range 14-65) and 50.7% were males. Their marital status was married (52.2%), single (31.4%), widowed (7.8%), divorced (6.3%) and unknown (2.3%). The occupation was known for 305(87.9%) patients: housewives 86(24.8%), office employees 74(21.3%), car driver 36(10.4%), unemployed 31(8.9%), merchant 28(8.1%), daily laborer 21(6.1%), student 5(1.4%) and others 24 (6.9%).

The objectives of our study were to assess the clinical presentation, cause, treatment, outcome and predictors of mortality in patients with HIV/AIDS with neurologic complications admitted to the largest referral hospital in Ethiopia. Both sexes were equally affected unlike other studies [7,8,10,11] where males outnumbered females. Majority of our patients were young (mean age 34.6 years) which is similar to other studies [7-11]. There was delay at presentation (mean duration of symptoms prior to presentation was 30.6 days). The mean duration of symptoms prior to presentation for patients with cerebral toxoplasmosis (25 days) and cryptococcal meningitis (26 days) was similar to another study [2]. Majority (66.3%) of cases were known to have HIV infection after current hospital admission. Almost all patients had advanced HIV disease at presentation (4.3% stage III and 95.7% stage IV) which is consistent with another study [8].

The authors declare that they have no competing interests.

AA wrote the first draft of the paper and all authors contributed comments and suggestions to various draft versions. TB participated in study design and data collection. YM participated in study design and coordinated the study. All authors have seen and approved the final manuscript.