Neurological manifestations in HIV-infected patients: a retrospective cohort study in Northeastern Iran

Abstract

Background: Neurological complications are a severe aspect of HIV infection, impacting patient outcomes significantly. This study investigates the prevalence and types of neurological syndromes among HIV-infected patients and their outcomes in northeastern Iran. Objective: To evaluate the prevalence and types of neurological syndromes in HIV-infected patients, assess predictors of mortality, and compare survival rates between those with neurological versus non-neurological conditions. Methods: A retrospective cohort study was conducted at major referral centers in northeastern Iran from 2011 to 2021. The study included adult HIV-infected patients admitted to the hospitals. Neurological diagnoses were categorized into central nervous system (CNS) involvement, peripheral nervous system involvement, and further categorized. Results: The cohort comprised 173 patients with a median age of 40 years (interquartile range, 33-46.8). Neurological syndromes were observed in 22.7% of admissions, with CNS involvement being predominant (93.3%). Neurological complications included primary HIV-associated syndromes (11.6%), infections (33.3%), autoimmune disorders (3.3%), vascular phenomena (3.3%), and neoplasms (1.7%). The in-hospital mortality rate was 22.9%, increasing to 35.6% among patients admitted with neurological syndromes as the primary cause of hospitalization. Significant mortality predictors included male sex (p < 0.001; OR: 3.95, 95% CI: 2.21–7.05), intravenous drug use (p: 0.018; OR: 2.22, 95% CI: 1.18–4.18), neurological syndromes (p = 0.023; OR = 2.07, 95% CI: 1.11–3.86), and altered consciousness (p = 0.004; OR = 3.31, 95% CI: 1.49–7.33). Kaplan-Meier survival curves demonstrate a continuous decline in survival rates since hospital admission, with a 36-month survival rate dropping to 36.3%. Survival rates for patients with neurological syndromes were significantly lower compared to those with other conditions (log-rank p = 0.008). 17.24% of deaths in those with neurological syndromes occurred within 24 h of admission. Conclusion: This study highlights the significant burden of neurological complications among HIV-infected patients, with a notable impact on mortality rates. Neurological infectious diseases accounted for one-third of neurological syndromes among HIV-infected patients. The identified predictors of mortality provide critical insights for healthcare providers, emphasizing the importance of early intervention strategies. Given the high rates of early in-hospital mortality associated with neurological syndromes, there is a need for enhanced monitoring and tailored therapeutic approaches for this vulnerable population.