Pattern And Outcome Of Neurological Manifestations Of Hiv/Aids - A Review Of 154 Cases In A Nigerian University Teaching Hospital - A Preliminary Report

Background The HIV is neurotropic and clinicians need to be aware of its myriad neurologic manifestations, as these may be the only clinical presentation. Objective To evaluate the clinical spectrum and outcome of the neurologic manifestations in patients with HIV / AIDS over a ten year period. Design case - note based retrospective follow-up study. Settings Olabisi Onabanjo University Teaching Hospital; Nigeria. Participants Patients attending the HIV outpatient clinic and medical in-patients with AIDS. Intervention Treatment was symptomatic and specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used routinely. Main Outcome Measure Neurologic impairment related to HIV / AIDS and its sequelae within 6 months. Results A total of 362 patients with HIV / AIDS were reviewed over a ten-year period, of which 154 patients, (42.5%) had neurological manifestations. Forty-five (29%) patients had Herpes zoster, 40 (26%) had TB meningitis (TBM), 19 (12%) had vacuolar myelopathy (VM), another 19 (12%) had AIDS dementia complex (ADC), 15 (9.7%) had toxoplasma encephalitis, 10 (6.5%) had distal sensory polyneuropathy, 4 (2.6%) had inflammatory demyelinating polyneuropathy, and 2 (1.3%) had subacute combined degeneration of the spinal cord. An overall 6-months fatality of 45% was recorded with ADC, VM and TBM as predictors of high fatality. Conclusion Herpes zoster appears to be the commonest neurological manifestation while TBM is the commonest AIDS defining illness. Our experience indicates that unusual neurological manifestations could be the first manifestation of HIV/AIDS, and there is need for awareness of these entities by practising doctors for prompt diagnosis and treatment. Screening of all patients with Herpes zoster for HIV is also advised. Introduction Le VIH est neurotrophique et les praticiens doivent etre vigilants compte tenu du caracere polymorphe des manifestations neurologiques cliniques. But Evaluer les aspects cliniques et l\'evolution des manifestations cliniques chez des patients HIV/SIDA durant une periode de 10 ans. Methodes Il s\'agit d\'une etude retrospective realisee a l\'Olabisi Onabanjo University Teaching Hospital (Nigeria) chez des patients en ambulatoire pour les seropositifs ou hospitalises, pour les sideens. Le traitement etait symptomatique et rarement tritherapie. Resultats 362 patients VIH / SIDA ont ete etudies sur une periode de dix ans. 154 patients (42.5%), presentaient des manifestations neurologiques. Quarante cinq patients (29%) avaient un zona, 40 (26%) une meningite tuberculeuse (TBM), 19 (12%) une myeopathie vacuolaire (VM), 19 (12%) une demence (AIDS dementia complex, ADC), 15 (9.7%) une toxoplasmose cerebrale, 10 (6.5%) une polyneuropathie distale sensitive, 4 (2.6%) une polyneuropathie demyelinisante inflammatoire, and 2 (1.3%) une myelopathie subaigue subacute. Conclusion Le zona apparait comme etant la manifestation neurologique la plus commune. Notre experience montre que les manifestations neurologiques inhabituelles peuvent etre les premieres manifestations du VIH/SIDA et interpelle tout medecin en presence de tout malade atteint d\'un zona. Keywords : Africa, AIDS, HIV, Nigeria, Neurological, Afrique, neurosida, VIH, SIDA African Journal of Neurological Sciences Vol. 24 (1) 2005: pp. 29-36