Central Nervous System Infections in HIV-Infected Patients Hospitalized at King Chulalongkorn Memorial Hospital
Siriporn Kongsiriwattanakul MD*, Chusana Suankratay MD, PhD*
Affiliation : * Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Central nervous system (CNS) infections are among one of the most common complications in HIV-infected
patients. The present study aimed to determine the etiologies, clinical features, treatment, and outcomes of all CNS infections
in HIV-infected patients.
Material and Method: A retrospective study was carried out in all adult HIV-infected patients with CNS infection who were
hospitalized at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from January 1, 2007 to December 31, 2008.
Medical records of the patients were identified by extensively searching the disease codes based on International Classification
of Diseases-10, all microbiological data, and all histopathological data.
Results : One hundred forty eight patients were enrolled. There were 103 males (69.6%) with the mean age of 36.1 + 8.9 years
(range 15 to 75 years). Among 93 patients with available data, the median and percentage of CD4 cell count during
hospitalization were 64.0 cells/microlitre and 6% (range 1-684 cells/microlitre and 1-57%). Among 106 patients with known
HIV infection, 67 patients (63.2%) had received antiretroviral therapy with the mean duration of 1.6 + 2.1 years. The most
common CNS infection was cryptococcal meningitis (56 patients, 37.8%), followed by tuberculosis (53, 35.8%), toxoplasmosis
(19, 12.8%), progressive multifocal leukoencephalopathy (6, 4.1%), varicella-zoster virus (VZV) meningitis (4, 2.7%), brain
abscess (3, 2.1%), cytomegalovirus radiculomyelitis (2, 1.4%), pneumococcal meningitis (2, 1.4%), herpes simplex encephalitis,
Epstein-Barr virus-related primary CNS lymphoma, and HIV-associated myelopathy (1 patient, each, 0.7%). Twenty-two
patients died, accounting for the mortality rate of 14.9%. Of these 22 patients, tuberculous meningitis was the most common
cause (9 patients, 16.9%), followed by cryptococcal meningitis (9, 16.1%), VZV encephalitis, Aspergillus brain abscess,
herpes simplex encephalitis, and pneumococcal meningitis (1, 4.8% each).
Conclusion : To the authors’ knowledge, this is the first comprehensive study in Thailand to investigate the etiologies, clinical
manifestations, and outcomes of all CNS infections in AIDS patients. There are a high number of patients with tuberculosis
and severe immunodeficiency in the present study. The authors’ findings suggest an urgent need to actively search and treat
most HIV-infected patients in the community before they become severely immunocompromised.
Keywords : Central nervous system infections, HIV, AIDS, Opportunistic infections, Toxoplasmosis, Cytomegalovirus, Cryptococcal meningitis
