Abstract
Primary HIV-1 infection is a relevant period for its virological and epidemiological consequences. Most patients present a symptomatic disease that can be potentially serious, but neurological involvement during primary HIV-1 infection has been poorly studied. The aim of this study was to describe the characteristics and outcomes of primary HIV-1 infection patients presenting neurological symptoms and to compare them with primary HIV-1 infection patients without neurological involvement. Retrospective case-control study (1:3) comparing primary HIV-1 infection patients with and without neurological involvement enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016. Matching criteria included age (±10 years), gender, year of diagnosis (±4 years), and Fiebig stage. The conditional logit model was used for comparisons. Fourteen out of 463 patients (3.02%) enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016 presented neurological symptoms. 28.5% of cases presented as meningitis and 71.5% as meningoencephalitis. Cerebrospinal fluid showed non-specific findings, including pleocytosis with lymphocyte predominance and increased protein levels. All cases required hospitalisation, whereas only 19% of the controls did. No other pathogen was identified in any case, but five patients initiated empirically antimicrobial treatment for other aetiologies until diagnosis was confirmed. CD4/CD8 ratio was significantly lower (p = 0.039) and plasmatic viral load significantly higher in the case group, compared to controls (p = 0.028). Risk factors, HIV-1 tropism, subtype distribution, and prescribed ART regimens were comparable between cases and controls. After 6 months on ART, 92% of cases had undetectable viral load, similar to controls, and CD4/CD8 ratio became also comparable between groups. All cases recovered rapidly with ART and were discharged without sequels. Neurological involvement during primary HIV-1 infection is unusual but serious, always requiring hospitalisation. Diagnosis is difficult because of the wide range of symptoms and similarities with other viral aetiologies. Neurological manifestations during primary HIV-1 infection are associated with a lower CD4/CD8 ratio and with a higher viral load than controls. Immediate ART initiation and rapid viral load decrease are required, allowing complete clinical recovery.
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J.A. developed this work in the frame of a “Juan de la Cierva 2012” post-doctoral programme, Ministerio de Competitividad, Spain. F.Ar. developed this work as part of the MD degree research project, School of Medicine, University of Barcelona, Barcelona, Spain. D.N. developed this work in the frame of a post-residency scholarship Ajuts a la Recerca “Josep Font” 2014, Hospital Clinic, Barcelona, Spain. F.Ag. developed this work in the frame of a “Rio Hortega 2012” grant CM12/00195, Ministerio de Competitividad, Spain. J.P. developed this job as a part of an FSG (Fundaciόn SEIMC-GESIDA) fellowship during 2016–17. J.M. received a personal intensification research grant #INT15/00168 during 2016 from Instituto de Salud Carlos III, Madrid, Spain and a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19.
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JA, Far, DN, and JMM designed the study, collected the information, perform the analysis, and draft the manuscript. JP, FAg, and EdL performed all the statistical analysis. JA, DN, CM, FAg, and JMM evaluated and followed-up all patients of the study. SSP, MAM, MMM, and MP performed all the virological laboratory determinations. All authors have read and approved the final manuscript
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Ambrosioni, J., Artigues, F., Nicolás, D. et al. Neurological involvement in patients with acute/recent HIV-1 infection. A case-control study. J. Neurovirol. 23, 679–685 (2017). https://doi.org/10.1007/s13365-017-0548-6
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DOI: https://doi.org/10.1007/s13365-017-0548-6