Neurological Complications in HIV Infection/AIDS Dr.K.Bujji Babu, MD., HIV Physician Consultant Bujji Babu HIV Clinic KanuruVijayawada

Introduction Deadly DUO in HIV infection --Opportunistic infections --Opportunistic infections -- Neoplasms -- Neoplasms Team effort -- HIV physician -- HIV physician -- Neurologist -- Neurologist -- Radiologist, Microbiologist & -- Radiologist, Microbiologist & Pathologist Pathologist

Discuss patient profiles in AIDS Diagnostic dilemmas Treatment: Options, Complications, Limitations AIMS

Epidemiology Duration: 2 years Total no HIV/AIDS cases: 490 No of patients with neurological complications:50 Male:Female: 31:19 Age group : years

Patient Profile Clinical examinations Laboratory Investigations Confirmation of serological status by ELISA/W.B Confirmation of serological status by ELISA/W.B Hb%, TC, DC, ESR, VDRL, Hep A,B & C, S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG for Toxo, Montoux, CXR, USG abdomen, Urine examination Hb%, TC, DC, ESR, VDRL, Hep A,B & C, S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG for Toxo, Montoux, CXR, USG abdomen, Urine examination CD4 for Immunological status CD4 for Immunological status

CNS Examination Clinical Examination Examination of fundus Laboratory study CSF Study CSF Study Chemical Analysis, AFB, Gramstain, Culture sensitivity, KOH, VDRL, Indian Ink Preparation for Crypto, Cryptococcal antigen, PCR. Chemical Analysis, AFB, Gramstain, Culture sensitivity, KOH, VDRL, Indian Ink Preparation for Crypto, Cryptococcal antigen, PCR. MRI study MRI study

Tubercular meningitis No. of Patients: 8 (M:F-5:3) Clinical Features: Fever, Headache & Vomiting CSF Analysis AFB Positive for 3 (1F, 2 M) AFB Negative for 5 (1F, 4M) AFB Negative for 5 (1F, 4M) CD4 count Mortality: One patient died in advanced stage, even after shunting for TBM with hydrocephalous

TB Spine No. of Patients : 2 (M:F-1:1) Clinical Features: Fever, Backache, Loss of weight Diagnosis : MRI spine Treatment : ATT followed by ART Results:Therapeutic response very good both TBM & TB spine when the CD4 > 150

Cryptococcal Meningitis No. of patients: 8 [M:F- 5:3] Clinical features: Throbbing Headache, Fever, Occasional Convulsions. CD4 < 150 CSF: High Pressure, Clear Fluid Indian ink for Cryptococcus +ve (5 cases) Cryptococcal antigen +ve (3 cases) Treatment: Fluconazole 200mg IV BD, Amphotericin B 0.7mg/kg & followed by ART Mortality: 2 [M:F-1:1]

Toxoplasmosis No. of Patients: 6 ( M:F- 5:1) Clinical Features: Fever & Seizures Diagnosis: Serum IgG Toxo, MRI CD4 < 200 Treatment: Anti TOXO Alternative: Clindamycin & Dapsone Followed by ART Followed by ART Mortality: 1

PML No. of Patients: 6 (M:F- 4:2) Clinical features: Loss of memory, irrelevant speech, insomnia Diagnosis : MRI CD4 <150 Treatment: Symptomatic & ART Mortality: 1

Cerebral Atrophy No. of Patients: 3 (M:F-2:1) Clinical Features: Loss of memory,irrelevant speech,insomnia insomnia insomnia Diagnosis – MRI CD4 < 150 Treatment: Symptomatic & ART

Pneumococcal Meningitis No. of patients – 2 (M) Clinical Features: Fever, Headache and vomiting Diagnosis: CSF analysis, Gram stain / CultureRx Treatment : standard+ ART Results: 1 patient died, CD4 = 27, one patient survive CD4 = 150

HIV Myelopathy with Myopathy 1 (F) patient Clinical Features: Tingling sensation & weakness in lower limbs CD4:110 Treatment : ART

Facial Palsy due to Herpes- Zoster No. of cases: 6 (M:F-4:2) Diagnosis – Clinical CD4 < 200 Treatment: Acyclovir, Famcyclovir, Valcyclovir Physiotherapy Physiotherapy

Peripheral Neuropathy No. of Patients: 5 (M:F- 3: 2) No. of Patients: 5 (M:F- 3: 2) Cause : Mainly drug induced Clinical Features: Numbness, tingling sensations & weakness in lower limbs CD4 : 50 – 150 Diagnosis : Clinical and NCS Treatment : Vitamin supplements

Spinal Masses Other than KOCHs No. of Patients: 3 (M:F- 2:1) Clinical Features: Fever, Paraplegia,Urinary retention, Bowel incontinence CD4; < 100 Diagnosis: MRI & Biopsy Results : 1(M) Secondary from renal cell Ca. - died 1(M) NHL operated - doing well 1(M) NHL operated - doing well 1(F) Spinal inflammatory/Neoplastic lesions nature not known (died because neutropenia) 1(F) Spinal inflammatory/Neoplastic lesions nature not known (died because neutropenia)

Conclusion TBM, Crypto, Toxo CD4 < 200 Cerebral atrophy & PML Neoplasms common CD4 <100 Neuro AIDS -- More common -- high morbidity -- Very high mortality -- ART