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High mortality rate and aetiologies of central nervous system infections among HIV-1-infected patients from Gabon.
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ObjectiveIn sub-Saharan Africa, data on acute central nervous system (CNS) infections observed in HIV-1-infected subjects are very scarce. The goal of this study, conducted in Gabon (Central Africa), was to assess the mortality rate and aetiologies of CNS infections among HIV-1-infected subjects, receiving or not highly active antiretroviral therapy (HAART).MethodsFrom November 2009 to April 2010, a prospective case series study was conducted in two Gabonese cities. Standardized clinical, laboratory and imaging data were collected among HIV-1-infected subjects presenting an acute febrile neurological impairment.Results Of 22 cases (woman, 54%; median age, 43 years), all but three patients were untreated with HAART. A high proportion (60%) of subjects ignored their HIV serostatus before their neurological impairment. The main clinical presentation was encephalitis (80%). Among the patients who could be clinically followed-up (n=20), 10 (50%) died in a median time of 11 days. All of them were untreated with HAART. Aetiological causes were found in 12 patients as follows: toxoplasmosis (n=5), tuberculosis (n=3), bacterial infection (n=2), Cryptococcus neoformans (n=1), and neurospyhilis (n=1). CMV DNA was detected in plasma from six (27%) patients, combined with a HSV DNA positive result for three of them, and a HHV-6 DNA positive result for one.ConclusionOur study revealed that, among late-presenting, severely immunosupressed HIV-1-infected adults, mostly untreated with HAART, acute neurological infections constitute a frequent and severe (mortality of ~50%) clinical entity, with a broad spectrum of aetiologies. It makes their diagnosis difficult to implement in resource-limited settings such as Gabon.
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