Brain mri findings in HIV/AIDS patients with neurological Symptoms at Muhimbili National Hospital, Dar es salaam.

Abstract

Background: HIV/AIDS is a pandemic infectious disease affecting about 36.7 million people globally, with 22 million out of these residing in the Sub-Saharan Africa. In Tanzania the preva-lence of HIV/AIDS is 5.1% with an estimated population of 1.4 million living with the disease. Approximately 40%-90% of patients with AIDS will develop CNS manifestations during the course of their illness. We studied brain MRI scans among HIV/AIDS patients who presented with clinical neurological manifestations at MNH. Methods: A cross sectional hospital based study was conducted for duration of six months among adult HIV/AIDS patients undergoing MRI brain imaging for neurological complaints at-tending Radiology and Internal medicine departments at Muhimbili National Hospital (MNH), Dar es Salaam. The interpretation of the MRI brain scans were done by the Principal Investigator and Radiologist and reported findings were stored in a data sheet along with recent CD4 counts, viral load ,ARV status and socio-demographic information retrieved from hospital records. Descriptive analyses were performed to summarize the data collected. To assess different asso-ciations, t-test or Wilcoxon test was used for continuous variables as appropriate while for cate-gorical variables, a Chi-square test or Fisher exact test was used accordingly. Lastly, a multivari-ate logistic regression was used to assess association of abnormal brain MRI findings with differ-ent predictors with results presented as odds ratios and plotted in a coefficient plot. All analyses were performed in Stata software version 13.1 (Stata Corporation, College Station, Texas, USA). Results: The mean age of participants was 44 years (age range from 18-66years), with females accounting for the higher proportion (74.3%) amongst the 101 enrolled participants. Most partic-ipants were from Dar es Salaam, predominantly from Ilala district. Out of 101 brain MRI scans of the study population, 67% had abnormal findings predominantly among patients with CD4 cell count below 200cells/μL and viral load above 50 copies/mL. In-farct, diffuse global abnormalities (defined as cerebral atrophy with/without symmetrical white matter hyperintensities) and focal mass lesions with mass effect accounted for more than half xi (62%) of the abnormal brain MRI findings. In a multivariate logistic regression adjusted for viral load and CD4 cell counts, patients with viral loads above 50 copies/mL had twice the odds of ab-normal MRI as compared to those with less than 50 copies/mL (i.e., aOR 2.06, 95% CI 0.48-8.82) while those whose CD4 cell counts are above 200 cells/μL had 67% decrease in the odds of having abnormal MRI findings (aOR 0.33, 95% CI 0.07-1.5). Participants with seizure disorder had a 83% increase in the odds of having abnormal MRI finding as compared to patients without seizure disorders (aOR 1.83, 95% CI 0.33-10.4). Conclusion: Neuro-imaging is a crucial component in the management of HIV/AIDS patients presenting with neurological symptoms especially those with low CD4 counts (≤200 cells/μL) and viral load above 50copies/mL. Due to higher sensitivity and soft tissue resolution, MRI of the brain is a useful aid in the diagnosis and treatment response assessment of HIV/AIDS patients with neurological manifestations.