Comparative Analysis of Neuroinfectious Disorders in HIV-Positive and HIV-Negative Patients in Bogotá: A Retrospective Study (2021-2024)
Juan Oyola1, Mariana Medina1, Juan Martinez Lemus3, Hugo Paez2, Claudio Jimenez1, Maria Reyes1
1Grupo de Investigación de Neuroepidemiología Clínica, Department of Neurology, 2Department of Infectology, Unidad de Servicios en Salud Simón Bolivar, Subred Integrada de Servicios en Salud Norte E.S.E, 3Movement Disorders Division, McGovern Medical School at UTHealth Houston
Objective:
To compare the clinical and paraclinical characteristics of neuroinfectious disorders (ND) in Human Immunodeficiency Virus (HIV) positive and negative patients at a single center in Bogotá.
Background:
Severe immunosuppression due to HIV can lead to heterogeneous clinical presentations and nonclassic features of cerebrospinal fluid (CSF) analysis of neuroinfectious disorders, which may impact early diagnosis and treatment.
Design/Methods:
Retrospective, cross-sectional study of ND patients admitted to the ND Division from 2021 to 2024. Sociodemographic, clinical, and paraclinical characteristics, including HIV status, were collected. Non-parametric tests and simple logistic regressions were conducted using SPSS v25.
Results:
153 patients with ND were included, 67.33% of whom were HIV-positive. HIV-positive patients were younger (median 39, IQR 27-43, p=0,012). The median CD4+ cell count for the HIV group was 77 cells/µL (IQR 30-219). Social factors such as being a migrant, a member of the LGBTQ+ community, and violence displacement victims were associated with HIV-positive status (OR=3.76, CI95%:[1.50-9.57], p=0.005). Encephalitis was the most common clinical presentation, with a predominant subacute temporal pattern in both subgroups. HIV-positive patients had a lower cell count (median 5, IQR 2-19, p<0.003) and higher total protein levels (median 65, IQR 42-118, p=0.019) in the CSF analysis. Lumbar puncture opening pressure was usually normal in both subgroups (HIV-positive median 15, IQR 11-25; HIV-negative median 16.5, IQR 10-33), (p=0.665). Tuberculosis infection was the most common etiological agent in HIV-positive patients (22.3%), whereas bacterial (34.0%) and viral (26.0%) were more prevalent in HIV-negative patients.
Conclusions:
ND in HIV-positive patients occurred at a younger age, mostly due to CNS Tuberculosis. The CSF was characterized by lower cell counts and more prominent protein elevation than seronegative patients. Common community-acquired etiologies of ND were more prevalent in the non-HIV group.
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