Clinical Characteristics of HIV/AIDS Central Nervous System Opportunistic Infections in Ecuadorian Patients

Background: Central nervous system (CNS) involvement is reportedly more common in AIDS-related infections. One of the leading causes of illness and death in people infected with the human immunodeficiency virus (HIV) is still infection of the central nervous system (CNS) by different opportunistic pathogens. In HIV immunocompromised patients, the clinical and radiographic pattern of CNS infection might occasionally be used to confirm the diagnosis.

Aim: The aim of this study is to describe the distribution of etiologies, clinical parameters, evaluation methods, management and complications in a group of patients treated in a hospital’s AIDS unit in a developing country.

Methodology: An observational retrospective analytical study was conducted at Eugenio Espejo Hospital, Quito-Ecuador, between April 2002 and June 2010.

Results: The prevalence of CNS infections in HIV patients was 5.9%. The main clinical manifestations were fever, headache and focal neurological deficits. The most common opportunistic infections were Toxoplasmosis 46%, Cryptococcosis 20%, Tuberculosis 19%, Encephalopathy 5%, and Progressive Multifocal Leukoencephalopathy (PML) 5%. In the first decade of the 2000s, antiretroviral therapeutic (ART) regimens were established in 84% of cases, of which 66% followed the guidelines for treatment-naïve patients (AZT/3TC/EFV). The prevalence of mortality throughout the study was 21.31%, being the most common fatal complication lactic acidosis 38%, Systemic Inflammatory Response Syndrome (SIRS) 38%, and Immune Reconstitution Inflammatory Syndrome (IRIS) 23%. The strategies for treatment adherence and reducing the risk of infections, combined with individual commitment, significantly improve both the virological response and ART resistance rates.

Conclusion: In Ecuador, until 2005, there were substantial rates of HIV-associated opportunistic CNS infections, which showed a dramatic reduction with the advent and consolidation of highly active antiretroviral therapy (HAART). Since molecular testing is only useful in specific situations and is not always available in developing countries with limited resources, many of the diagnostic methods covered here are still implemented today.