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 1 ^st , 2016, to 31 December 31 ^st , 2023, in Laquintinie and General hospitals in Douala. We reviewed all patient with HIV records, and we included those with HIV-related neurological complication. 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 15,521 admission, 1,058 (6.8%) were PLHIV, including 435 (41.1%) with 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 overall mortality rate was 29.4%. In multivariate analysis, cerebral toxoplasmosis (aOR:4.57, 95%CI:1.59 – 13.17, p=0.005), and meningoencephalitis of unknown etiology (aOR: 1.78, 95%CI:1.03–3.06, p=0.038) were independent predictors of death. 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.