Cranial computed tomography assessment of HIV/AIDS patients with neurological features

Abstract

Background: HIV/ AIDS patients do have variable neurological manifestation of the disease that will require neuro-imaging for proper evaluation. Computed tomography is one of the neuro-imaging techniques that can be used for diagnostic work up of patients with neurological symptoms and signs.

Objective: To determine the spectrum of cranial computed tomographic findings in HIV/AIDS patients with neurological signs and symptoms and correlate with CD4 count.

Methodology: This is a retrospective analysis of 43 HIV/AIDS patients who presented with neurological signs and symptoms and had cranial computed tomography from December 2014 to June 2018 (43 months).

Results: The mean age of subjects studied was 29±17 years with age range of 21-47 years. There were 27 males and 16 females with male to female ratio 1.7:1. Nineteen (44.2%) patients presented with one neurological sign and twenty-four (55.8%) presented with more than one neurological sign. Thirty-six (83.7%) of patients had abnormal CT findings. Cranial computed tomographic findings were cerebral infracts (27.9%), cerebral mass (18.6%), cerebral atrophy (16.3%), haemorrhage (7%). Others were meningeal enhancement (4.7%), brain oedema (4.7%) and white matter lesion (4.7%). Cerebral mass was the most common CT findings in patient with CD4 count less than 200cells/mm³. In subjects with CD4 count of 200-499 cells/mm³ and greater than 500cells/mm³, cerebral infracts and atrophy were the commonest CT findings respectively. There was statistically significant association between CD4 counts and abnormal CT findings in relation to cerebral infract and atrophy (cerebral infarcts, p=0.02 and cerebral atrophy p=0.02).

Conclusion: Cerebral infracts was the commonest CT findings in this study. CT plays an important role in evaluation of HIV/AIDS patient with neurological features. CT scan should be a routine investigation in HIV/AIDS patients with low CD4 count presenting with neurological signs and symptoms in view of the abnormalities seen in them from our study.

Keywords: Cranial findings, computed tomographic, HIV/AIDS, CD4 count