Neurological manifestations in people living with HIV/AIDS in the late cART era: a prospective observational study at a tertiary healthcare center in São Paulo, Brazil

Figures & data

Table 1. Baseline characteristics of people living with HIV/AIDS admitted due to neurological disorders at the Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.

Characteristics	All patients (n = 105)
Male gender, n (%)	65 (61%)
cART prior, n (%)	95 (90%)
Regular	24 (26%)
Irregular or abandoned	71 (74%)
Prophylaxis use, n (%)	54 (51%)
Irregular use	52 (96%)
Age, median (IQR)	42.8 (34-51)
Age at HIV diagnosis, median (IQR)	31.7 (25-39)
Time HIV diagnosis -hospital admission (years), median (IQR)	10.5 (1.3-17)
CD4 lymphocyte count (cell/mm^3), median (IQR)	70 (27-160)
HIV viral load (copies/mm^3), median (IQR)	18,903 (372-200,000)
Time symptoms-admission (days), median (IQR)	12 (5-25)
Length of stay (days), median (IQR)	36 (20-58)

Note. cART – combination antiretroviral therapy; IQR – interquartile range.

Table 2. Neurological diseases diagnosed during hospitalization from patients living with HIV/AIDS admitted due to neurological disorders at Emilio Ribas Institute of Infectious Disease.

Neurological diseases	N = 121	Confirmed	Probable
Cerebral toxoplasmosis, n (%)	44 (36%)	3 (7%)	41 (93%)
Cryptococcal meningitis, n (%)	18 (14.8%)	18 (100%)	–
Tuberculous meningitis, n (%)	10 (8.2%)	3 (30%)	7 (70%)
Neurosyphilis, n (%)	9 (7.4%)	8 (89%)	1 (11%)
CMV encephalitis, n (%)	5 (4.1%)	4 (80%)	1 (20%)
CMV polyradiculopathy, n (%)	5 (4.1%)	1 (20%)	4 (80%)
Progressive multifocal leukoencephalopathy, n (%)	4 (3.3%)	2 (50%)	2 (50%)
Primary central nervous system lymphoma, n (%)	4 (3.3%)	4 (100%)	–
CMV retinitis, n (%)	4 (3.3%)	3 (75%)	1 (25%)
Septic encephalopathy, n (%)	3 (2.8%)	–	3 (100%)
Bacterial meningitis, n (%)	2 (1.6%)	2 (100%)	–
HIV-related seizures, n (%)	2 (1.6%)	–	2 (100%)
Tropical spastic paraparesis, n (%)	1 (0.8%)	1 (100%)	–
Ramsay-Hunt syndrome, n (%)	1 (0.8%)	1 (100%)	–
Guillain-Barré syndrome associated with HSV-1, n (%)	1 (0.8%)	1 (100%)	–
HSV-1 retinitis, n (%)	1 (0.8%)	1 (100%)	–
HIV-related distal sensory polyneuropathy, n (%)	1 (0.8%)	-	1 (100%)
Glioblastoma multiforme, n (%)	1 (0.8.%)	1 (100%)	–
Neurocysticercosis, n (%)	1 (0.8%)	1 (100%)	–
Pott’s disease, n (%)	1 (0.8%)	1 (100%)	–
HIV encephalitis*, n (%)	1 (0.8%)	1 (100%)	–
Herpetic encephalitis, n (%)	1 (0.8%)	1 (100%)	–
Mixed germ cell tumor, n (%)	1 (0.8%)	1 (100%)	–

Note. CMV – Cytomegalovirus; HSV-1 – herpes simplex virus type 1; *HIV-associated dementia.

Table 3. Etiological diagnosis from patients living with HIV/AIDS admitted due to neurological complaints at the Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.

Etiological diagnosis	N = 121
Toxoplasma gondii, n (%)	44 (36%)
Cryptococcus neoformans, n (%)	18 (15%)
Cytomegalovirus, n (%)	14 (11.5%)
Mycobacterium tuberculosis, n (%)	11 (9%)
Treponema pallidum, n (%)	9 (7.5%)
Malignancies, n (%)	6 (5%)
AIDS malignancies	4 (3.3%)
Non-AIDS malignancies	2 (1.6%)
Others, n (%)	19(15.5%)

Note. AIDS – acquired immune deficiency syndrome.

Figure 1. Survival analysis in relation to altered level of consciousness in patients living with HIV/AIDS admitted for neurological complaints at the Instituto de Infectologia Emílio Ribas between January and August 2017.

Figure 2. Survival analysis in relation to ICU admission in patients living with HIV/AIDS admitted for neurological complaints at the Instituto de Infectologia Emílio Ribas between January and August 2017.

Table 4. Descriptive analysis of prognostic factors associated with death in people living with HIV/AIDS admitted due to neurological diseases at the Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.

Variables	Death (N = 13)	Control (N = 92)	P
Age (years), median [IQR]	45 [33-49]	42 [35-51]	0.853
Male, n (%)	9 (69)	56 (61)	0.561
Time between HIV diagnosis and hospital admission (months), median [IQR]	115 [2-186]	128 [19-208]	0.321
CD4+ lymphocyte cell count (cell/mm^3), median (IQR)	28 [8-151]	72 [30-162]	0.104
HIV viral load (copies/ml), median [IQR]	121,208	15,407	0.091
Previous opportunistic infections, n (%)	8 (61)	55 (59)	0.904
cART experienced, n (%)	10 (76)	85 (92)	0.075
Prophylaxis use, n (%)	46 (50)	8 (61)	0.436
Days between first symptoms and hospital admission, median [IQR]	11 [5-25]	14 [2-26]	0.95
Altered level of consciousness, n (%)	12 (92)	24 (26)	<0.0001
Neurological coinfection, n (%)	3 (23)	12 (13)	0.333
Central nervous system coinfection, n (%)	3 (23.1)	9 (9.8)	0.158
Intensive care unit admission, n (%)	9 (69)	18 (19)	<0,0001
Number of neurological complaints on hospital admission, median [IQR]	4 [1.5-4]	3 [2-4]	0.747

Table 5. Univariate analysis of prognostic factors associated with death in people living with HIV/AIDS admitted due to neurological diseases at the Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.

Variables	P	OR	IC 95%
CD4+ lymphocyte cell count < 50 cel/mm^3	0,016	4.6	1.3-16
HIV viral load > 15,407 copies/ml	0.2	2.2	0.6-7.5
cART naive patients	0.092	3.6	0.8-16
Altered level of consciousness	0.001	34	4-275
Central nervous system coinfection	0.173	2.7	0.64-12
ICU admission	0.001	9.2	2.5-33

Note. cART: combined antiretroviral therapy; ICU: intensive care unit.

Table 6. Multivariate analysis of prognostic factors associated with death in people living with HIV/AIDS admitted due to neurological diseases at the Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.

Variables	P	OR	IC
Altered level of consciousness	0.04	22.7	2.6-195.1
ICU admission	0.014	6,2	1.4-26.7

Note. ICU: intensive care unit.