TY - JOUR
T1 - Encephalitis in HIV-infected adults in the antiretroviral therapy era
AU - Reimer-Mcatee, Melissa
AU - Ramirez, Denisse
AU - Mcatee, Casey
AU - Granillo, Alejandro
AU - Hasbun, Rodrigo
N1 - Funding Information:
Rodrigo Hasbun has research support and personal fees from Biofire®. No other authors have any potential conflicts of interest. Melissa Reimer-McAtee was funded by NIH Fogarty Global Health Research Training Grants when analyzing the data and writing the manuscript [grant numbers D43TW0009340, D43TW012275]. The work was also supported by the Grant A Starr Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Grant A Starr Foundation.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Encephalitis presents with high morbidity and mortality in both HIV-infected and HIV-negative patients. There are currently no studies comparing HIV-infected and HIV-negative patients admitted to the hospital with acute encephalitis. Methods: We conducted a multicenter, retrospective study of adults admitted to the hospital with a diagnosis of encephalitis in Houston, Texas between 2005 and 2020. We describe the clinical manifestations, etiology, and outcomes of these patients with a focus on those infected with HIV. Results: We identified 260 patients with encephalitis, 40 of whom were infected with HIV. Viral etiology was identified in 18 of the 40 HIV-infected patients (45.0%); bacterial in 9 (22.5%); parasitic in 5 (12.5%); fungal in 3 (7.5%); immune-mediated in 2 (5.0%). Eleven cases had unclear etiology (27.5%). More than one disease process was identified in 12 (30.0%) patients. HIV-infected persons were more likely to have neurosyphilis (8/40 vs. 1/220; OR 55; 95%CI 6.6–450), CMV encephalitis [5/18 vs. 1/30; OR 11.2 (1.18–105)], or VZV encephalitis (8/21 vs. 10/89; OR 4.82; 1.62–14.6) compared to the HIV-negative patients. Inpatient mortality was similar in the HIV-infected and HIV-negative patients, 15.0% vs 9.5% [p = 0.4, OR 1.67 (0.63–4.44)], but one-year mortality was higher for the HIV-infected patients, 31.3% vs 16.0% [p = 0.04, OR 2.40 (1.02–5.55)]. Conclusion: This large, multicenter study shows that HIV-infected patients with encephalitis have a distinct pattern of disease when compared with HIV-negative patients, and that this population has nearly twice the odds of mortality in the year following hospitalization.
AB - Introduction: Encephalitis presents with high morbidity and mortality in both HIV-infected and HIV-negative patients. There are currently no studies comparing HIV-infected and HIV-negative patients admitted to the hospital with acute encephalitis. Methods: We conducted a multicenter, retrospective study of adults admitted to the hospital with a diagnosis of encephalitis in Houston, Texas between 2005 and 2020. We describe the clinical manifestations, etiology, and outcomes of these patients with a focus on those infected with HIV. Results: We identified 260 patients with encephalitis, 40 of whom were infected with HIV. Viral etiology was identified in 18 of the 40 HIV-infected patients (45.0%); bacterial in 9 (22.5%); parasitic in 5 (12.5%); fungal in 3 (7.5%); immune-mediated in 2 (5.0%). Eleven cases had unclear etiology (27.5%). More than one disease process was identified in 12 (30.0%) patients. HIV-infected persons were more likely to have neurosyphilis (8/40 vs. 1/220; OR 55; 95%CI 6.6–450), CMV encephalitis [5/18 vs. 1/30; OR 11.2 (1.18–105)], or VZV encephalitis (8/21 vs. 10/89; OR 4.82; 1.62–14.6) compared to the HIV-negative patients. Inpatient mortality was similar in the HIV-infected and HIV-negative patients, 15.0% vs 9.5% [p = 0.4, OR 1.67 (0.63–4.44)], but one-year mortality was higher for the HIV-infected patients, 31.3% vs 16.0% [p = 0.04, OR 2.40 (1.02–5.55)]. Conclusion: This large, multicenter study shows that HIV-infected patients with encephalitis have a distinct pattern of disease when compared with HIV-negative patients, and that this population has nearly twice the odds of mortality in the year following hospitalization.
KW - AIDS
KW - Altered mental status
KW - Confusion
KW - Encephalitis
KW - HIV
KW - Outcomes
KW - Inpatients
KW - HIV Infections/complications
KW - Humans
KW - Adult
KW - Retrospective Studies
KW - Hospitalization
UR - http://www.scopus.com/inward/record.url?scp=85153727392&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85153727392&partnerID=8YFLogxK
U2 - 10.1007/s00415-023-11735-w
DO - 10.1007/s00415-023-11735-w
M3 - Article
C2 - 37115358
AN - SCOPUS:85153727392
SN - 0340-5354
VL - 270
SP - 3914
EP - 3933
JO - Journal of Neurology
JF - Journal of Neurology
IS - 8
ER -