AEGiS-14IAC: Utility of Cerebrospinal fluid (CSF) examination as an essential aid in the diagnosis of CNS-HIV disease in a resource -- limited setting.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Utility of Cerebrospinal fluid (CSF) examination as an essential aid in the diagnosis of CNS-HIV disease in a resource -- limited setting.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10173)

Prabhu VA
Institute of STD.Madras Medical College, Chennai, India

BACKGROUND: Increasing frequency of neurological complications leads to devastating neurologic disease. In a resource-limited setting with scarce access to specific tests and non invasive radiological services-CT scan/MRI,CSF examination provides the diagnostic inputs and guides therapy in HIV seropositive patients with neurological involvement. METHODSA prospective study over a period of 2 years was conducted on in-patients of a STD Institute of a tertiary level government hospital in South India. Serological tests for syphilis and ELISA for HIV were done along with routine biochemistries. Lumbar puncture was performed and CSF was analysed for cell count,protein,sugar, VDRL,TPHA,gram,acid fast(AFB),Indian ink staining, bacterial and fungal cultures, and latex agglutination test for detection of cryptococcal antigen.

RESULTS: In134patients CSFexamination was used as a diagnostic tool. Neurosyphilis was diagnosed in 32%of syphilis patients, 60%of whom had HIV infection. CSF VDRL reactivity was seen in only 10.25%of syphilis cases, of which 38% had concomittant HIV infection. CSFabnormalities were detected in all stages of syphilis, with or without HIV infection.62%had neurological symptoms.64%had meningitis diagnosed after CSF analysis,of which 81%had HIV infection alone and 19% had concomittant syphilis. Latex agglutination test for detection of cryptococcal antigen was positive in 28%of meningitis cases. Indian Ink staining was positive in only 33% of these cases. CSF AFB staining was negative in all cases.

CONCLUSIONS: Basic CSF parameters viz proteins, glucose, cell counts, staining and cultures helped in arriving at a clinical diagnosis but stopped short of a specific etiology. The addition of expensive specific tests-latex agglutination, polymerase chain reaction were needed to arrive at an etiological diagnosis. In a resource- limited setting, CSF analysis still remains an invaluable tool for diagnosing CNS-HIV infections.

Keywords: AEGIS, HIV Infections, HIV Seropositivity, Neurosyphilis, Central Nervous System Diseases, Syphilis, Health Resources, Syphilis Serodiagnosis, Spinal Puncture, Fluorescent Treponemal Antibody-Absorption Test, False Negative Reactions, Cerebrospinal Fluid Proteins, Prospective Studies, India, Human, diagnosis, cerebrospinal fluid, Surgical Procedures, Operative, instrumentation

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B10173