Table 2.
Causes of neurological deterioration within one year of ART initiation in 75 HIV seropositive patients
| n | (%) | |
|---|---|---|
| CNS tuberculosis | 27 | (36) |
| Paradoxical TB-IRIS 1 | 16 | (21) |
| TB meningitis (n=8) | ||
| Tuberculoma (n=6) | ||
| TB arachnoiditis (n=1) | ||
| TB spinal epidural abscess (n=1) | ||
| New diagnosis of neurological TB | 4 | (5) |
| TB meningitis (n=3) | ||
| TB arachnoiditis (n=1) | ||
| MDR-TB | 2 | (3) |
| Deterioration due to poor adherence | 5 | (7) |
| Cryptococcal meningitis [CSF culture positive 2] | 18 [12] | (24) |
| Paradoxical CM-IRIS 1 | 5 [1] | (7) |
| Culture-positive relapse on ART 1 | 4 [4] | (5) |
| New diagnosis of CM | 9 [7] | (12) |
| Intracerebral space occupying lesion 5 | 10 | (13) |
| Cerebral toxoplasmosis | 1 | (1) |
| Uncertain aetiology 6 | 9 | (12) |
| Psychosis | 9 | (12) |
| EFV-induced | 5 | (7) |
| HIV-induced | 2 | (3) |
| INH-induced | 1 | (1) |
| Reactive psychosis | 1 | (1) |
| Other | 11 | (15) |
| Seizure | 3 | (4) |
| CMV encephalitis | 2 | (3) |
| HIV encephalopathy | 2 | (3) |
| Isolated abducens nerve palsy | 1 | (1) |
| VZV radiculopathy | 1 | (1) |
| Bacterial meningitis | 1 | (1) |
| RIND | 1 | (1) |
See definitions in the text.
CSF culture positive for Cryptococcus neoformans at time of deterioration
Space occupying lesions other than tuberculoma
The most likely differential diagnoses included tuberculoma and toxoplasmosis
Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; CNS, central nervous system; TB-IRIS, tuberculosis-associated immune reconstitution inflammatory syndrome; TB, tuberculosis; MDR-TB, multidrug-resistant TB; CSF, cerebrospinal fluid; CM-IRIS, cryptococcal meningitis immune reconstitution inflammatory syndrome; EFV, efavirenz; INH, isoniazid; CMV, cytomegalovirus; VZV, varicella zoster virus; RIND, reversible ischemic neurological deficit