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Published on: June 23, 2022
Prospective analysis of seizures occurring in human immunodeficiency virus type-1 infection
Insights
Seizures in human immunodeficiency virus type-1 (HIV-1) infection primarily affect patients with advanced disease. Opportunistic central nervous system (CNS) infections are common, but foscarnet therapy and subclinical HIV-1 CNS involvement may also trigger seizures.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Human Immunodeficiency Virus type-1 (HIV-1) infection can lead to various neurological complications.
- Seizures represent a significant neurological manifestation in individuals with HIV-1.
- Understanding the underlying causes of seizures in HIV-1 is crucial for effective management.
Purpose of the Study:
- To characterize seizures in patients with HIV-1 infection.
- To identify associated conditions and risk factors for seizures in this population.
- To investigate potential triggers in cases where no clear cause is identified.
Main Methods:
- A prospective case-control study design was employed.
- Fifty patients with documented seizures in the context of HIV-1 were compared to fifty control patients.
- Cerebrospinal fluid (CSF) biomarkers (â2-microglobulin, neopterin) and patient treatment data were analyzed.
Main Results:
- Seizures predominantly occurred in patients with advanced HIV-1 disease (low CD4 counts, prior AIDS-defining illnesses).
- Opportunistic CNS infections like cerebral toxoplasmosis and cryptococcal meningitis were common causes.
- In patients without identifiable causes, foscarnet therapy (18%) and elevated CSF markers of CNS involvement were noted.
Conclusions:
- Seizures in HIV-1 are associated with advanced disease and opportunistic CNS infections.
- Foscarnet therapy and subclinical HIV-1 CNS involvement are potential contributors to seizures in some patients.
- Further investigation into these factors may elucidate seizure mechanisms in HIV-1.
Abstract:
A prospective, case-control study was undertaken to characterise seizures occurring in the context of human immunodeficiency type-1 (HIV-1) infection. Fifty consecutive patients with a documented seizure were enrolled along with fifty control patients. Among cases the median CD4 cell count was 8/mm3 and 84% had a prior AIDS defining illness; 14/mm3 and 80% among the control group. Generalised seizures were seen in 84%, partial with secondary generalisation in 10% and partial in 6%. Associated conditions included cerebral toxoplasmosis (22%), cryptococcal meningitis (8%), progressive multifocal leukoencephalopathy (6%), cytomegalovirus encephalitis (6%), central nervous system (CNS) lymphoma (2%), and other causes (14%) including pre-HIV epilepsy. No associated condition was identified in 42% of patients of whom 18% were receiving foscarnet therapy at the time of seizure, compared with 4% of control patients (p < 0.001). Concentrations of cerebrospinal fluid â2-microglobulin and neopterin, markers that have been associated with HIV-1 involvement of the CNS, were elevated in 12/12 and 13/13 patients, respectively, of the group with no identifiable cause for their seizure. We conclude that seizures occur principally in patients with advanced HIV-1 disease, with opportunistic infections of the CNS the predominant underlying condition. In the group with no identifiable cause foscarnet therapy and subclinical HIV-1 involvement of the CNS may be factors responsible for seizure activity.
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