New-onset seizure in HIV-infected adult Zambians

Siddiqi, Omar K.; Elafros, Melissa A.; Bositis, Christopher M.; Koralnik, Igor J.; Theodore, William H.; Okulicz, Jason F.; Kalungwana, Lisa; Potchen, Michael J.; Sikazwe, Izukanji; Birbeck, Gretchen L.

doi:10.1212/wnl.0000000000003538

Cited by 22 publications

(29 citation statements)

References 22 publications

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“…In a prospective study in Zambia[ 38 ], HIV infected patients with a new onset of seizures were enrolled and underwent CSF testing within two weeks of the index seizure. Three patients had a reactive serum RPR and TPHA, but no individual had a positive CSF VDRL.…”

Section: Resultsmentioning

confidence: 99%

Neurosyphilis in Africa: A systematic review

et al. 2017

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IntroductionNeurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of HIV co-infection on clinical neurosyphilis remains unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore it might be expected that neurosyphilis would be an important and not uncommon manifestation of syphilis in Africa and frequently occur in association with HIV co-infection; yet few data are available on neurosyphilis in Africa. The aim of this study is to review data on neurosyphilis in Africa since the onset of the HIV epidemic.MethodsWe searched the literature for references on neurosyphilis in Africa for studies published between the 1st of January 1990 and 15th February 2017. We included case reports, case series, and retrospective and prospective cohort and case-control studies. We did not limit inclusion based on the diagnostic criteria used for neurosyphilis. For retrospective and prospective cohorts, we calculated the proportion of study participants who were diagnosed with neurosyphilis according to the individual study criteria. Depending on the study, we assessed the proportion of patients with syphilis found to have neurosyphilis, and the proportion of patients with neurological syndromes who had neurosyphilis. Due to heterogeneity of data no formal pooling of the data or meta-analysis was undertaken.ResultsAmongst patients presenting with a neurological syndrome, three studies of patients with meningitis were identified; neurosyphilis was consistently reported to cause approximately 3% of all cases. Three studies on stroke reported mixed findings but were limited due to the small number of patients undergoing CSF examination, whilst neurosyphilis continued to be reported as a common cause of dementia in studies from North Africa. Ten studies reported on cases of neurosyphilis amongst patients known to have syphilis. Studies from both North and Southern Africa continue to report cases of late stage syphilis, including tabes dorsalis and neurosyphilis, in association with ocular disease.DiscussionThis is the first systematic review of the literature on neurosyphilis in Africa since the beginning of the HIV epidemic. Neurosyphilis continues to be reported as a manifestation of both early and late syphilis, but the methodological quality of the majority of the included studies was poor. Future well-designed prospective studies are needed to better delineate the incidence and clinical spectrum of neurosyphilis in Africa and to better define interactions with HIV in this setting.

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Section: Resultsmentioning

confidence: 99%

Neurosyphilis in Africa: A systematic review

et al. 2017

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“…This differs from our approach which retrospectively reviewed all the patients that presented to our HIV neurology clinic and then investigating possible risk factors that may have contributed towards those who developed developing seizures. Another relevant study is the ongoing Cohort of HIV-associated Seizure and Epilepsy (CHASE) study which continues to provide important new data on the epidemiology underlying epilepsy in HIV-infected Zambian population [29]. While this study is exclusively recruiting adults, it does show similarities to our study in that aetiology of epilepsy in HIV-infected patients appears to be similarly caused by infections, usually in patients with advanced HIV disease.…”

Section: Discussionmentioning

confidence: 76%

Seizures in Children with HIV infection in South Africa: A retrospective case control study

Burman

Wilmshurst

Gebauer

et al. 2019

Seizure

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A B S T R A C TPurpose: Data relating to the role that Human immunodeficiency virus (HIV) contributes towards seizures in HIV-infected children is limited. The management of seizures in this group is complex due to potential interactions between antiseizure medication and antiretroviral therapies. This study explores the seizure semiology and course of a population of affected children based on questions raised from a previous epidemiological study. Methods: A retrospective case-control study of all patients presenting to an HIV neurology clinic between 2008-2015 was conducted. A multinomial logistic regression model was used to identify risk factors for seizure occurrence in HIV-infected children, as well as factors associated with seizure control. Results: Of 227 HIV-infected children (median 82 months, interquartile range 41-109), 52 (23%) reported a past or present history of seizures. Prior bacterial meningitis (p = 0.03, OR 12.5, 95% CI 1.2-136.1), cerebrovascular accident (CVA, p = 0. 005, OR 8.1, 95% CI 1.9-34.9) and or tuberculous meningitis (TBM, p = 0.0004) was associated with an increased risk of seizures in HIV-infected children. Generalised tonic-clonic seizures were the predominant seizure type (64%) with the majority caused by an infectious aetiology (62%). Thirty-two (62%) of these patients had epilepsy in-line with the latest diagnostic criteria. HIV-infected children with epilepsy who were treated with efavirenz were more likely to have poor seizure control (OR 23.1 95% CI 3.4-159.6, p = 0.0001). Conclusions:This study provides new data highlighting the complex clinical presentation and management challenges of HIV-infected children with seizures.

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“…we also found that intital OIs (HR=4.910) and age (HR=1.336) predicted for LTFU or death in HIV patients. In other studies, the overall prevalence of OIs among HIV/AIDS patients on ART was 32.5-48% [76,77], OIs that emerge very early after ART also confer an increased risk of early mortality [78].Besides, the impact of age on HIV patients has always been a topic.An exaplanation for this trend may be that older patients have poorer immunological responses than their younger counterparts [79]. Furthermore, successful ART has led to a growing number of older HIV-1-infected individuals who face both age-related and HIV-1-related inflammation, which may synergistically promote physical decline [80,81].We also found that HBV co-infection had no effect on HIV patients' loss of follow-up or death [4,32,56].…”

Section: Discussionmentioning

confidence: 99%

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

Guo

Wang

et al. 2019

Preprint

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There is limited long-term data on the effect of ART on clinical outcomes in HIV/HBV patients in China. The objective of this study was to understand the ART treatment effect and the factors associated with the loss to follow-up or death of HIV/HBV co-infected patients in the city of Beijing, China. Methods: This study examined clinical indicators for HIV mono-infected or HIV/HBV co-infected patients from Jan. 2010 to Sep. 2018. Included patients were followed for a mean duration of 34.5 months after ART. Covariance analysis for repeated measures was used to analyze the changes of clinical indicators; multivariate logistic regression and Cox model were used to analyze the influencing factors of the abnormal incidence of clinical indicators and the lost to follow-up or death in HIV patients. Results: A total of 841 HIV/HBV co-infected patients and 2000 HIV patients were analyzed. Adherence was estimated to be 93% in all patients. At baseline, ALT, AST, OIs and APRI≥0.5 in HIV/HBV patients were higher, while the CD4 and CD4/CD8 ratio were lower. After ART treatment, the rate of APRI≥0.5 (4.4%) were still higher in HIV/HBV patients and HBV co-infection affect the prevalence of APRI≥0.5 (OR=2.745, 95% CI 1.041-7.243). The variables related to LTFU or death in HIV patients were initial CD4 (HR=0.784, 95% CI 0.652-0.943), APRI≥0.5 (HR=4.647, 95% CI 1.331-16.227), OIs (HR=4.910, 95% CI 2.352-10.247) and age (HR=1.336, 95% CI 1.004-1.778). HBV coinfection was not associated with increased LTFU or overall mortality in HIV patients (p>0.05). Conclusion: With good ART treatment and adherence rate, the clinical indicators were improved significantly in HIV/HBV co-infected patients. However, the incidence of hepatic fibrosis was higher in these patients.

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New-onset seizure in HIV-infected adult Zambians

Cited by 22 publications

References 22 publications

Neurosyphilis in Africa: A systematic review

Neurosyphilis in Africa: A systematic review

Seizures in Children with HIV infection in South Africa: A retrospective case control study

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

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