HIV/AIDS Patient with a “Neuro” presentation. Diagnostic Approach

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Presentation transcript:

HIV/AIDS Patient with a “Neuro” presentation. Diagnostic Approach HIV Infection of the CNS HIV/AIDS Patient with a “Neuro” presentation. Diagnostic Approach Conrad K. Muzoora Mbarara University Eric Miller - Epi 227 - 24 April 2013 1

How Does HIV Affect the Nervous System? HIV Infection of the CNS How Does HIV Affect the Nervous System? HIV easily crosses the blood-brain barrier Dave R, Pomerantz RJ. (2005). HIV neuropathogenesis: persistent infection, persistent questions. Science & Medicine. Eric Miller - Epi 227 - 24 April 2013 2

How Does HIV Affect the Nervous System? HIV Infection of the CNS How Does HIV Affect the Nervous System? Primary HIV Disease can lead to: AIDS Dementia Complex (brain) Vacuolar Myelopathy (spinal cord) Peripheral Neuropathy (nerve) Meningitis (acute and chronic) Eric Miller - Epi 227 - 24 April 2013 3

How Does HIV Affect the Nervous System? HIV Infection of the CNS How Does HIV Affect the Nervous System? General immunosuppression can lead to: Opportunistic Infections Fungal (Cryptococcal Meningitis) Parasitic (Toxoplasmosis) Viral (Progressive Multifocal Leukoencephalopathy) HIV-Related Tumors Eric Miller - Epi 227 - 24 April 2013 4

For Today we concentrate on CNS Infections due to reduced Immunity HIV Infection of the CNS For Today we concentrate on CNS Infections due to reduced Immunity Acute Chronic Bacterial Meningitis Tuberculosis Meningitis Viral Meningitis Cryptococcal meningitis Eric Miller - Epi 227 - 24 April 2013 5

CCM Clinical History Serum Diagnostics CSF Based Diagnosis Indian Ink 70-80% CRAG-latex 97% Crag-LFA 99% Culture 90% PCR Biofire: Under evaluation 85%vs98% Prel

Crag LFA (Immy)

Biofire

TBM Very Challenging to Diagnose High Index of suspicion. Clinical most of the time as opposed to laboratory confirmation

clinical case definition as described by Marais Definite, Probable, Possible Clinical criteria score 6 CSF criteria Score 4 Cerebral imaging criteria score 6 Evidence of tuberculosis elsewhere =4 Exclusion of alternative diagnoses

Current CSF Diagnostics ZN Smear very low yeald max 15-20% after large volume csf centrifugation Genexpert 43% Ultra 70% Culture 43% Nathan C Bahr & ASTRO Lancet Infect Dis 2017

Goals of Current Research HIV Infection of the CNS Goals of Current Research Early and timely diagnosis of TBM in Late Stage HIV Early and Timely diagnosis of asymptomatic crypto and effective prevention Improve outcomes for TBM and CCM Eric Miller - Epi 227 - 24 April 2013 12

HIV Infection of the CNS Thank You Eric Miller - Epi 227 - 24 April 2013 13