Computerized tomography brain scan findings in symptomatic human immunodeficiency virus infected adult patients at the Moi Teaching and Referral Hospital, Eldoret, kenya

Abstract

Background:Human Immunodeficiency Virus (HIV)is a major global health issue. HIV is neuro-invasive and neuro-virulent causing Central Nervous System(CNS) complications in 40-70% ofHuman Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients. Computerized Tomography (CT) is a non-invasive diagnostic tool use to investigate patients with clinical signs suggestive of central nervous system involvement. Objective:To describe the Computerized Tomography brain findings of HIV-infected adult patients and relate these findings to Antiretroviral Therapy (ART) use. Methods: A cross-sectional study conducted between January 2015 and December 2015. Ninety-five HIV-infected adult patients with CNS presentation who underwent a contrast enhanced brain CT were enrolled. Data was collected using a structured questionnaire. Data on patient demographics, clinical presentation and ART-use were collected at the time of presentation and correlated with brain CT findings. Frequencies were calculated. Odds ratios used to assess associations. A p-values of <0.05 was considered significant. Results: Ninety-five participants were included in the study. The mean age of participants was 39.8 years. Brain CT scans were abnormal in 65.3%(n=62). Parenchymal pathology was seen in 44.2% (n=42). Most parenchyma lesions are hypodense (n=39), non-enhancing (n=37) and located in the frontoparietal region. Ventricular pathology was seen in 35.8% (n=34). Meningeal pathology was seen in 11.65% (n=11). Encephalitis was the most common finding in 27.4% (n=26). Toxoplasmosis was the only opportunistic infection seen in 2.1% (n=2). Brain pathology was significantly higher in male compared to the female, OR 2.5 (95% CI 1.0-6.0), p=0.046. Prevalence of brain pathology was significantly lower in participants 40 years and below, compared to participants over 40 years, OR 0.3 (95% CI 0.1-0.8), p=0.010. there was no significant association betweenART use and common brain CT findings (p>0.05). Focal and multifocal lesions are significantly higher in patients who were on ARTs (13.5%) while none of their counterparts reported such lesions (p=0.015). Conclusions: Prevalence of brain pathology was 65.3%. Most lesions were hypodense, non-enhancing and located in the frontoparietal region. The most common finding was Encephalitis. Toxoplasmosis was the only opportunistic infection diagnosed. Antiretroviral therapy use was not a determinant of brain pathology. Focal and multifocal parenchymal lesions were only seen in participants on ARTs. Recommendation: A large prospective studies should be conducted to further evaluate the relationship, if any, between CT findings and Antiretroviral Therapy use