HIV-associated neurological infections in a Brazilian tertiary care center: clinical-epidemiological features and predictors of in-hospital mortality.

Neurological manifestations remain a significant cause of hospitalization and in-hospital mortality among people living with HIV (PLWH), even in the era of antiretroviral therapy (ART). This study aims to describe the clinical and epidemiological profile of PLWH with neurological opportunistic infections (nOIs) and to identify factors associated with in-hospital mortality. We conducted a retrospective cohort study with PLWH aged >18 years hospitalized due to nOIs between November 2017 and December 2021 at a tertiary hospital in Brazil. Demographic, clinical, and laboratory data were extracted from electronic medical records. Logistic regression was used to evaluate associations between patient characteristics and in-hospital mortality. Among 237 hospitalized PLWH, 89 (37.6%) had nOIs. The median CD4 count at admission was 55 cells/mm³ (IQR 22.5-149), and 91.7% had previously used ART (only 22.7% used it regularly). The most frequent infections were cerebral toxoplasmosis (50.6%), cryptococcal meningitis (10.1%), and progressive multifocal leukoencephalopathy (9%). A total of 19 in-hospital deaths occurred. In the multivariate analysis, undefined neurological infections (aOR: 8.67; 95%CI: 1.23-61.17) and ICU admission (aOR: 58.61; 95% CI: 10.24-335.49) were independently associated with mortality. In conclusion, severe immunosuppression and low ART adherence were common in this cohort. Cerebral toxoplasmosis was the most prevalent neurological infection. ICU admission and undefined neurological syndromes were strong predictors of in-hospital mortality. Early diagnosis, prompt treatment, and strategies to improve ART adherence are essential to reduce fatal outcomes in this population.