Clinical profile of central nervous system space-occupying lesions and their association with CD4 counts in patients with HIV: A prospective observational study

Vinayak M Sawardekar; Ritesh K Sawadh; Veena Sawardekar; Balbir Singh; Bhushan Wankhade

doi:10.4103/jfmpc.jfmpc_1180_23

Clinical profile of central nervous system space-occupying lesions and their association with CD4 counts in patients with HIV: A prospective observational study

J Family Med Prim Care. 2024 Mar;13(3):952-957. doi: 10.4103/jfmpc.jfmpc_1180_23. Epub 2024 Apr 4.

Authors

Vinayak M Sawardekar¹, Ritesh K Sawadh¹, Veena Sawardekar², Balbir Singh¹, Bhushan Wankhade¹

Affiliations

¹ Department of Medicine, The Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India.
² Department of Anesthesiology, The Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India.

Abstract

Background: Neurological manifestations are one of the major concerns for patients with human immunodeficiency virus (HIV). The secondary spectrum includes space-occupying lesions (SOL), including tuberculoma, cryptococcosis, candidiasis, toxoplasmosis, primary central nervous system lymphoma (PCNSL), and progressive multifocal leukoencephalopathy (PML).

Aim: To assess the neurological manifestations, disease outcome, and their associations with cluster of differentiation 4 (CD4) counts in patients with HIV.

Materials and methods: This single-center, prospective, observational study was performed in the Department of General Medicine of a tertiary care institute, over a period of 2 years (January 2017 to December 2018). The study included 150 known or newly diagnosed HIV patients with CNS SOL. The physical examination, laboratory investigations, and imaging were conducted on every patient, and the findings were noted.

Results: The patients mainly presented with hemiparesis (52%), had involvement of the frontal region (38.7%), and were diagnosed with tuberculoma (29.3%). Other diagnoses were toxoplasmosis (22.7%), PML (17.3%), PCNSL (15.3%), brain abscess (10%), and neurocysticercosis (5.3%). Of 150 patients, 136 (90.7%) were survivors, while 14 (9.3%) were non-survivors. The mean CD4 count was significantly less in patients with toxoplasmosis (P < 0.0001) and PCNSL (P = 0.02), and significantly higher in patients with tuberculoma (P < 0.0001) and brain abscess (P = 0.0009) relative to other causes of SOL. Moreover, the mean CD4 count was not significantly associated with survivors and non-survivors (P = 0.28).

Conclusion: In patients with HIV, CD4 count was significantly low in toxoplasmosis and PCNSL, and high in tuberculoma and brain abscess.

Keywords: CD4 count; HIV; PCNSL; space-occupying lesions; toxoplasmosis; tuberculoma.