Correlation between CD4 count and cerebrospinal fluid inflammatory response in human immunodeficiency virus (HIV) infected patients with cryptococcal meningitis
Date
2022
Authors
Mashitela, Sandra Refiloe
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Abstract
Introduction: Cryptococcal meningitis is the most common central nervous system opportunistic infection in HIV seropositive individuals in sub – Saharan Africa, with South Africa having the highest prevalence. The cerebrospinal fluid findings indicate a lack of inflammatory response. Our study investigates if the cerebrospinal fluid (CSF) inflammatory response can be correlated to CD4+ counts level.
Methods: This was a retrospective cohort study of all patients with HIV associated cryptococcal meningitis at Charlotte Maxeke Johannesburg Academic Hospital. Demographics, CD4+counts and CSF findings were collected through all discharge summaries. Spearman’s rank-order correlation statistic was used to assess the correlation between CD4+ counts and cerebrospinal fluid (CSF) inflammatory response. An R of +1 suggests a positive correlation, and a p-value < 0.05 was considered significant.
Results: One hundred and thirteen patients were included in the study. All were HIV seropositive, 44.25% (n = 50) were newly diagnosed and 44.25% (n = 50) were known. Thirtyfour out of the fifty in the known HIV category were on antiretroviral treatment. Eighty – three percent (n = 94) of patients had CD4+ counts that were under 100 cells/ µL with the median
CD4+ count of 21 cells/µL [Interquartile range (IQR): 9.00 – 56.00]. There was no statistically significant correlation between CSF polymorphonuclear cells and CD4+ count with a p-value of 0.068; however, there was a significant correlation with CSF protein with a p-value of 0.008.
Conclusion: There was a partial correlation between CD4+ counts and cerebrospinal fluid inflammatory response. Antiretroviral treatment did not significantly impact the CSF fluid
inflammatory response, as suggested by other studies.
Description
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Neurology to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021