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Omar K. Siddiqi, Musie Ghebremichael, Xin Dang, Masharip Atadzhanov, Patrick Kaonga, Michael N. Khoury, Igor J. Koralnik, Molecular Diagnosis of Central Nervous System Opportunistic Infections in HIV-Infected Zambian Adults, Clinical Infectious Diseases, Volume 58, Issue 12, 15 June 2014, Pages 1771–1777, https://doi.org/10.1093/cid/ciu191
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This is the first comprehensive study in sub-Saharan Africa looking at the full spectrum of central nervous system opportunistic infections in the HIV population. This study highlights that multiple pathogens are often present in the cerebrospinal fluid of individuals living with HIV.
Background. Knowledge of central nervous system (CNS) opportunistic infections (OIs) among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa is limited.
Methods. We analyzed 1 cerebrospinal fluid (CSF) sample from each of 331 HIV-infected adults with symptoms suggestive of CNS OI at a tertiary care center in Zambia. We used pathogen-specific primers to detect DNA from JC virus (JCV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) types 1 and 2, Mycobacterium tuberculosis, and Toxoplasma gondii via real-time polymerase chain reaction (PCR).
Results. The patients' median CD4+ T-cell count was 89 cells/µL (interquartile range, 38–191 cells/µL). Of 331 CSF samples, 189 (57.1%) had at least 1 pathogen. PCR detected DNA from EBV in 91 (27.5%) patients, M. tuberculosis in 48 (14.5%), JCV in 20 (6.0%), CMV in 20 (6.0%), VZV in 13 (3.9%), HSV-1 in 5 (1.5%), and HSV-2 and T. gondii in none. Fungal and bacteriological studies showed Cryptococcus in 64 (19.5%) patients, pneumococcus in 8 (2.4%), and meningococcus in 2 (0.6%). Multiple pathogens were found in 68 of 189 (36.0%) samples. One hundred seventeen of 331 (35.3%) inpatients died during their hospitalization. Men were older than women (median, 37 vs 34 years; P = .01), more recently diagnosed with HIV (median, 30 vs 63 days; P = .03), and tended to have a higher mortality rate (40.2% vs 30.2%; P = .07).
Conclusions. CNS OIs are frequent, potentially treatable complications of AIDS in Zambia. Multiple pathogens often coexist in CSF. EBV is the most prevalent CNS organism in isolation and in coinfection. Whether it is associated with CNS disease or a marker of inflammation requires further investigation. More comprehensive testing for CNS pathogens could improve treatment and patient outcomes in Zambia.
- polymerase chain reaction
- hiv
- acquired immunodeficiency syndrome
- osteogenesis imperfecta
- seizures
- herpesvirus 4, human
- simplexvirus
- inflammation
- central nervous system
- adult
- africa south of the sahara
- dna
- human herpesvirus 1
- human herpesvirus 2
- human herpesvirus 3
- jc virus
- molecular diagnostic techniques
- mycobacterium tuberculosis
- neisseria meningitidis
- opportunistic infections
- streptococcus pneumoniae
- t-lymphocytes
- tuberculosis
- zambia
- cerebrospinal fluid
- cryptococcus
- cytomegalovirus
- mortality
- pathogenic organism
- hiv infections
- toxoplasma gondii
- coinfection
- oxygenation index measurement
- patient-focused outcomes
