HIV-related neurological complications in Cameroon in the era of Test and Treat strategy: prevalence and mortality.

BACKGROUND: Neurological complications are common in HIV infection and can occur at any stage of the disease. These conditions could be associated with poor outcome. This study aimed to determine the prevalence of HIV-related neurological complications and to identify factors associated with mortality among these patients. MATERIALS AND METHOD: This was a retrospective cohort study from January 1st, 2016, to 31 December 31st, 2023, in Laquintinie and General hospitals in Douala. We reviewed all records of patients living with HIV, and we included those with HIV-related neurological complications. Demographic, clinical, laboratory, neuroimaging, and therapeutic data were collected. Univariate and multivariate logistic regression analysis were performed to identify predictive factors of mortality. RESULTS: Among the 15,521 admissions, 1,058 (6.8%) were people living with HIV (PLVIH), including 435 (41.1%) admitted for HIV-related neurological complications. The mean age was 45.5 ± 11.7 years, and 58.4% were women. CD4 count and viral load were unavailable in more than 85% of cases. Cerebral toxoplasmosis (33.3%), meningoencephalitis of undetermined etiology (25.3%), and cryptococcal meningitis (9.2%) were the most common etiologies. The in-hospital mortality rate among patients with HIV-related neurological complications was 29.4%. In the multivariable analysis, cerebral toxoplasmosis (aOR:4.0, 95% CI:1.4–11.0, p = 0.009) and meningoencephalitis of undetermined etiology (aOR: 1.8, 95% CI: 1.0–3.1, p = 0.038) were independent predictors of in-hospital mortality. CONCLUSION: HIV-related neurological complications remain common and deadly in our setting, with cerebral toxoplasmosis and meningoencephalitis of unknown etiology emerge as major contributors to mortality. Limited access to immunovirological and advanced diagnostic testing likely contribute to delayed diagnosis and poor outcomes. Prospective studies are needed to refine diagnostic algorithm and improve survival in affected patients.