Background: Central nervous system (CNS) involvement is reportedly
more common in AIDS-related infections. One of the leading causes of illness
and death in people infected with the human immunodeficiency virus (HIV) is
still infection of the central nervous system (CNS) by different opportunistic
pathogens. In HIV immunocompromised patients, the clinical and radiographic
pattern of CNS infection might occasionally be used to confirm the diagnosis.
Aim: The aim of this study is to describe the distribution of
etiologies, clinical parameters, evaluation methods, management and complications
in a group of patients treated in a hospital’s AIDS unit in a developing
country.
Methodology: An observational retrospective analytical study was
conducted at Eugenio Espejo Hospital, Quito-Ecuador, between April 2002 and
June 2010.
Results: The prevalence of CNS infections in HIV patients was
5.9%. The main clinical manifestations were fever, headache and focal
neurological deficits. The most common opportunistic infections were
Toxoplasmosis 46%, Cryptococcosis 20%, Tuberculosis 19%, Encephalopathy 5%, and
Progressive Multifocal Leukoencephalopathy (PML) 5%. In the first decade of the
2000s, antiretroviral therapeutic (ART) regimens were established in 84% of
cases, of which 66% followed the guidelines for treatment-naïve patients
(AZT/3TC/EFV). The prevalence of mortality throughout the study was 21.31%,
being the most common fatal complication lactic acidosis 38%, Systemic
Inflammatory Response Syndrome (SIRS) 38%, and Immune Reconstitution
Inflammatory Syndrome (IRIS) 23%. The strategies for treatment adherence and
reducing the risk of infections, combined with individual commitment,
significantly improve both the virological response and ART resistance rates.
Conclusion: In Ecuador, until 2005, there were substantial rates
of HIV-associated opportunistic CNS infections, which showed a dramatic
reduction with the advent and consolidation of highly active antiretroviral
therapy (HAART). Since molecular testing is only useful in specific situations
and is not always available in developing countries with limited resources,
many of the diagnostic methods covered here are still implemented today.
Author
(s) Details
César
Prócel Ramírez
Internal Medicine Department, Hospital Metropolitano, Ecuador and
Internal Medicine Department, Eugenio Espejo Hospital, Ecuador.
Lucy
Baldeón R.
Biomedical Research Institute, Central University of Ecuador,
Ecuador and Faculty of Medicine, Central
University of Ecuador, Ecuador.
Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v5/1723
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