Association between graded short-term lymphocyte count decline and epilepsy risk in HIV-positive patients: a retrospective cohort study.

To evaluate whether varying degrees of lymphocyte count decline in HIV-positive adults are associated with increased short-term incidence of epilepsy or convulsions. A retrospective cohort study was conducted using the TriNetX global research network. HIV-positive patients with a lymphocyte count ≥ 1.2 × 10³/µL were categorized based on subsequent decline within 3 months: mild (1.01-1.19), moderate (0.81-1.0), or significant (0.61-0.8). Risk analysis and Kaplan-Meier survival analysis were performed and patients with prior diagnosis of epilepsy (G40) or convulsions (R56.9) were excluded. The risk of developing epilepsy or convulsions increased with greater lymphocyte decline. Compared to patients with stable counts, the odds ratios were 1.073 for the mild group, 2.222 for the moderate group, and 3.189 for the significant drop group. Hazard ratios followed a similar trend, reaching 3.24 in the 0.61-0.8 group. Only the mild drop group did not show a statistically significant difference in risk or survival curves. Kaplan-Meier analysis at 1 year showed significant separation between survival curves for all groups except the mild group (p = 0.6973). Among HIV-positive adults, greater short-term lymphocyte count decline is associated with a higher short-term risk of epilepsy or convulsions. These findings suggest that lymphocyte trends may serve as an early signal for neurologic vulnerability. Further investigation is warranted to clarify the underlying mechanisms and clinical implications.