Table 1.
Characteristics and outcomes of 75 HIV seropositive patients presenting with neurological deterioration within one year of initiating ART
| Female, n (%) | 40 | (53) |
| Age in years, median (range) | 33 | (18–68) |
| Nadir CD4+ count, cells/μL, median (IQR) | 64 | (23–114) |
| WHO Staging, n (%) | ||
| Stage II | 2 | (3) |
| Stage III | 28 | (37) |
| Stage IV | 45 | (60) |
| ART regimen, n (%) | ||
| d4T/3TC/EFV | 50 | (67) |
| d4T/3TC/NVP | 14 | (19) |
| AZT/3TC/EFV | 6 | (8) |
| AZT/3TC/NVP | 4 | (5) |
| TDF/3TC/EFV | 1 | (1) |
| Current TB, n (%)1 | 44 | (59) |
| Pulmonary/Extra-pulmonary disease2, n/n | 27/22 | |
| Time from antituberculosis treatment initiation to starting ART in days, median (IQR) 3 | 56 | (34–100) |
| Previous TB, n (%) | 31 | (41) |
| Previous CM, n (%) | 11 | (15) |
| Time from ART initiation to symptom onset in days, median (IQR) | 23 | (9–89) |
| Paradoxical TB-IRIS, n=16 | 16 | (11–30) |
| Paradoxical CM-IRIS, n=5 | 58 | (27–88) |
| Time from symptom onset to presentation in days, median (IQR) | 4 | (3–14) |
| Paradoxical TB-IRIS, n=16 | 4 | (3–16) |
| Paradoxical CM-IRIS, n=5 | 3 | (2–4) |
| Outcome at 6 months, n (%) | ||
| Alive | 43 | (57) |
| Dead 4 | 17 | (23) |
| Lost to follow-up 5 | 15 | (20) |
Abbreviations: HIV, human immunodeficiency virus; ART, antiretroviral treatment; IQR, interquartile range; WHO, World Health Organization; d4T, stavudine; 3TC, lamivudine; EFV, efavirenz; NVP, nevirapine; AZT, zidovudine; TDF, tenofovir; TB, tuberculosis; CM, cryptococcal meningitis; TB-IRIS, tuberculosis-associated immune reconstitution inflammatory syndrome; CM-IRIS, cryptococcal meningitis immune reconstitution inflammatory syndrome
Includes all patients on antituberculosis treatment at the time of neurological deterioration (those who started prior to ART initiation (n=40), and those who started after ART initiation (n=4)).
Extra-pulmonary disease sites include: nodal (n=11), central nervous system (n=5), abdominal (n=4), pleural (n=4), pericardial (n=2); In 5 patients, both pulmonary and extra-pulmonary disease were present, in 3 patients more than 1 extra-pulmonary site of disease was present.
For 40 patients who started antituberculosis treatment prior to ART.
Deaths occurred in the following patient categories: intracerebral space occupying lesion (other than tuberculoma) (n=6), new diagnosis of neurological TB (n=2), poor adherence to antitubercular treatment (n=2), multidrug-resistant TB (n=1), new diagnosis of CM (n=3), cytomegalovirus encephalitis (n=1), HIV encephalopathy (n=2)
Lost to follow-up occurred in the following patient categories: paradoxical TB-IRIS (n=1), multidrug-resistant TB (n=2), poor adherence to antitubercular treatment (n=1), paradoxical CM-IRIS (n=1), culture positive CM relapse on ART (n=1), new diagnosis of CM (n=1), cerebral toxoplasmosis (n=1), intracerebral space occupying lesion of uncertain aetiology (n=1), EFV-induced psychosis (n=2), reactive psychosis (n=1), isolated abducens nerve palsy (n=1), varicella zoster virus radiculopathy (n=1), bacterial meningitis (n=1)