The pattern of central nervous system lesion in HIV-infected patients in the specialized unit of an infectious diseases hospital

• Main Authors: Alla Borisovna Peregudova, Vasiliy Iosifovich Shakhgil'dyan, Ol'ga Olegovna Tsvetkova, Tat'yana Nikiforovna Ermak, Boris Marlenovich Gruzdev, Mikhail Vladimirovich Yuditskiy, Oleg Aleksandrovich Tishkevich, Ol'ga Yur'evna Shipulina, Mariya Viktorovna Al'vares Figeroa, Anna Petrovna Safonova, Ekaterina Alekseevna Dolgova, Dmitriy Borisovich Goncharov, A B Peregudova, V I Shakhgildyan, O O Tsvetkova, T N Yermak, B M Gruzdev, M V Yuditsky, O A Tishkevich, O Yu Shipulina, M V Alvares Figeroa, A P Safonova, E A Dolgova, D B Goncharov
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2010-11-01
• Series: Терапевтический архив
• Subjects: hiv infection; central nervous system; brain; neurological diseases
• Online Access: https://ter-arkhiv.ru/0040-3660/article/view/30708

Aim. To define the incidence and features of brain lesion (BL) in HIV-infected inpatients. Subjects and methods. Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out. Results. In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection. Conclusion. The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.