Neurological Complications in HIV Infection/AIDS

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Neurological Complications in HIV Infection/AIDS

• Dr.K.Bujji Babu, MD., HIV Physician
• Consultant
• Bujji Babu HIV Clinic
• Kanuru
• Vijayawada

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Introduction

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

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AIMS

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

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Epidemiology

• Duration 2 years
• Total no HIV/AIDS cases 490
• No of patients with neurological complications50
  
• MaleFemale 3119
• Age group 25-55 years

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Patient Profile

• Clinical examinations
• Laboratory Investigations
• 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
• CD4 for Immunological status

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CNS Examination

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

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Tubercular meningitis

• No. of Patients 8 (MF-53)
• Clinical Features Fever, Headache Vomiting
• CSF Analysis
• AFB Positive for 3 (1F, 2 M)
• AFB Negative for 5 (1F, 4M)
• CD4 count
• Mortality One patient died in advanced stage,
  even after shunting for TBM with hydrocephalous

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TB Spine

• No. of Patients 2 (MF-11)
• Clinical Features Fever, Backache, Loss of
  weight
• Diagnosis MRI spine
• Treatment ATT followed by ART
• ResultsTherapeutic response very good both TBM
  TB spine when the CD4 gt 150

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Cryptococcal Meningitis

• No. of patients 8 MF- 53
• Clinical features Throbbing Headache, Fever,
  Occasional Convulsions.
• CD4 lt 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 MF-11

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Toxoplasmosis

• No. of Patients 6 ( MF- 51)
• Clinical Features Fever Seizures
• Diagnosis Serum IgG Toxo, MRI
• CD4 lt 200
• Treatment Anti TOXO
  Alternative Clindamycin Dapsone
• Followed by ART
• Mortality 1

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PML

• No. of Patients 6 (MF- 42)
• Clinical features Loss of memory, irrelevant
  speech, insomnia
• Diagnosis MRI
• CD4 lt150
• Treatment Symptomatic ART
• Mortality 1

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Cerebral Atrophy

• No. of Patients 3 (MF-21)
• Clinical Features
• Loss of memory,irrelevant speech,insomnia
• insomnia
• Diagnosis MRI
• CD4 lt 150
• Treatment Symptomatic ART

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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

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HIV Myelopathy with Myopathy

• 1 (F) patient
• Clinical Features Tingling sensation weakness
  in lower limbs
• CD4110
• Treatment ART

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Facial Palsy due to Herpes-Zoster

• No. of cases 6 (MF-42)
• Diagnosis Clinical
• CD4 lt 200
• Treatment Acyclovir , Famcyclovir ,
  Valcyclovir
• Physiotherapy

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Peripheral Neuropathy

• No. of Patients 5 (MF- 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

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Spinal Masses Other than KOCHs

• No. of Patients 3 (MF- 21)
• Clinical Features Fever, Paraplegia,Urinary
  retention, Bowel incontinence
• CD4 lt 100
• Diagnosis MRI Biopsy
• Results 1(M) Secondary from renal cell Ca. -
  died
• 1(M) NHL operated - doing well
• 1(F) Spinal inflammatory/Neoplastic lesions
  nature not known (died because neutropenia)

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Conclusion

• TBM , Crypto, Toxo CD4 lt 200
• Cerebral atrophy PML
• Neoplasms common CD4 lt100
• Neuro AIDS

• -- More common
• -- high morbidity
• -- Very high mortality
• -- ART

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Thank You