New-onset seizures among HIV infected drug naïve patients from south India

Abstract

Objective: The purpose of the study is to analyze the frequency, etiology and clinical aspects of seizures occurring among HIV infected patients presenting with neurological disorders from south India where HIV infection is due to clade C subtype. All were drug naive without antiretroviral therapy. Methods: Among the 500 HIV seropositive patients with neurological manifestations evaluated at a tertiary referral center and university teaching hospital (NIMHANS) at Bangalore (1989-2001), 99 patients who had new onset seizures were analyzed. Results: The mean age at presentation was 32.1 ± 7.5 years, male to female ratio was 11.4 : 1. The types of seizures were primary generalized in 62 patients (62.6%) and partial with/without generalization in 37 patients (37.4%) including 8 patients with status epilepticus. The mean duration of symptoms of underlying neurological illness was 23.7±52.1 days. Seizures, as the first symptom was noted in 20 patients. Seizure was difficult to control in 6.1% cases. Granulocytopenia (<4000/ cu. mm) was seen in 6 patients, 3 each of the phenytoin and phenobarbital treated patients. Ninety three patients (93.9%) had opportunistic infections, monomicrobial in 77.7% and polymicrobial in 16.2%. The underlying neurological illnesses were tuberculosis (44.4%), cryptococcosis (41.4%), toxoplasmosis (23.2%), HIV encephalitis (3.1%), and others (10.1%). Twenty five patients (25.3%) with seizures died compared to 95/401 patients (23.7%) without seizures. Conclusion: Approximately, one fifth of HIV infected drug naive patients with neurological disorders have new onset acute symptomatic seizures, mainly secondary to opportunistic neuroinfections. A fifth of these had seizures as their initial symptom. One fourth died because of underlying illness and presence of seizures did not alter the mortality rate.