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

摘要

Background:The aim of this study was to evaluate the frequency, spectrum, in-hospital mortality rate, and factors associated with death in people living with HIV/AIDS (PLWHA) presenting with neurological diseases from a middle-income country, as well as estimate its one-year global death rate. Methods:This prospective observational cohort study was conducted at a Brazilian tertiary health center between January and July 2017. HIV-infected patients above 18 years of age who were admitted due to neurological complaints were consecutively included. A standardized neurological examination and patient and/or medical assistant interviews were performed weekly until the patient's discharge or death. The diagnostic and therapeutic management of the included cases followed institutional routines. Results:A total of 105 (13.2) patients were included among the 791 hospitalized PLWHA. The median age was 42.8 34-51 years, and 61 were men. The median CD4+ lymphocyte cell count was 70 (27-160) cells/mm(3), and 90 of patients were experienced in combined antiretroviral therapy. The main diseases were cerebral toxoplasmosis (36), cryptococcal meningitis (14), and tuberculous meningitis (8). Cytomegalovirus causing encephalitis, polyradiculopathy, and/or retinitis was the third most frequent pathogen (12). Moreover, concomitant neurological infections occurred in 14 of the patients, and immune reconstitution inflammatory syndrome-related diseases occurred in 6 of them. In-hospital mortality rate was 12, and multivariate analysis showed that altered level of consciousness (P = 0.04; OR: 22.7, CI 95: 2.6-195.1) and intensive care unit (ICU) admission (P = 0.014; OR: 6.2, CI 95: 1.4-26.7) were associated with death. The one-year global mortality rate was 31. Conclusion:In this study, opportunistic neurological diseases were predominant. Cytomegalovirus was a frequent etiological agent, and neurological concomitant diseases were common. ICU admission and altered levels of consciousness were associated with death. Although in-hospital mortality was relatively low, the one-year global death rate was higher.