Brain computed tomography findings in HIV-infected adults presenting with impaired mental status: determining the value of CT in a resource constrained environment.
INTRODUCTION: HIV/AIDS is a global health problem, with Sub-Saharan Africa the most affected. “Neuro-AIDS” refers to the extensive neuropathological manifestations of the disease. Neuroimaging of the HIV-infected individual plays a fundamental role in their work-up. Limited resources, however, drive the development of imaging protocols based on clinical signs. ‘Confusion’ may or may not represent a significant presenting sign and needs to be investigated, as it is the basis of referral of a significant number of patients for CT scanning. AIM: To determine the frequency of positive findings of head CT in HIV-infected adults presenting with confusion with/without associated neurology, and correlate them with the degree of immunosuppression, presence of CSF abnormality and their ARV therapy status. METHOD: CT brain scans of adult patients, who were HIV-positive and presented with confusion in Johannesburg, Gauteng, were retrospectively reviewed. The neurological status, CD4 counts, LP results and their ARV therapy status were documented. RESULTS: 30% of our HIV-infected patients presented with confusion. There were 156 patients who were included. CT scans were abnormal in 81%. We found that ‘associated neurology’ was a weak predictor for abnormal CT, making it a poor screening tool. A positive LP was predictive of infection (p=0.04 for focal infection, p=0.03 for infected surface collection) and infarction (p<0.01) on CT. CD4 count, LP results and ARV therapy were found to be abnormal in the majority of patients. CONCLUSIONS: CT was abnormal in the majority of HIV-infected patients presenting with confusion. Neurology was an unreliable clinical indicator. A positive LP was a good predictor for CT evidence of infection and infarction. The clinical parameters such as CD4 counts, LP results and ARV therapy, were abnormal in the majority of patients. If any of these parameters are abnormal in a patient with a normal CT, we believe this should motivate for further imaging with MRI.