SUAC0205 | High mortality from cerebral toxoplasmosis among inpatients living with HIV at a tertiary facility in Ghana: a retrospective review

Vincent Ganu¹, Isaac Kyeremateng², Oluwakemi Oladele³, Emmanuella Amankwa¹, Peter Puplampu^1|4 | ¹Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana; ²Medical and Scientific Research Centre, University of Ghana Medical Centre, Accra, Ghana; ³Department of Psychiatry, Korle Bu Teaching Hospital, Accra, Ghana; ⁴Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana

The rollout of antiretroviral therapy (ART) has reduced the incidence of opportunistic infections globally. However, advanced HIV disease (AHD) continues to persist, largely due to the late diagnosis of HIV and/or delayed presentation of people living with HIV (PLHIV) for care, with cerebral toxoplasmosis being a common manifestation of AHD. West Africa has poorly documented clinical outcomes of cerebral toxoplasmosis. This study assessed clinical outcomes of inpatient PLHIV diagnosed with cerebral toxoplasmosis at a tertiary facility in Accra, Ghana. We reviewed the records of 226 adults (≥18 years). PLHIV with central nervous system (CNS)-related AHD at the Infectious Disease Center of Korle Bu Teaching Hospital between January 2010 and June 2020. Data on sociodemographic and clinical features and outcomes were extracted using a structured tool and analyzed using STATA (v19). Descriptive statistics were used to summarize patient characteristics, and a binary logistic regression was used to identify factors associated with mortality from cerebral toxoplasmosis. Among the 226 inpatients, the mean age was 41.6±10.6 years, and 57.1% (129/226) were female. About 57% (128/226) were newly diagnosed with HIV. HIV-1 was present in 91% (206/226). The median length of hospitalization was 5 days (IQR 2-10). Overall in-hospital mortality was 66% (149/226). Cerebral toxoplasmosis was the predominant diagnosis, 91% (205/226), followed by cryptococcal meningitis, 4% (9/226), and tuberculous meningitis, 4% (9/226). Among cerebral toxoplasmosis cases, 65.4% (134/205) died, with 54% (73/134) of deaths occurring within the first three days. Only 45% (102/226) of patients were able to do computed tomography (CT) imaging of the brain, with about 90% (93/102) reporting evidence of cerebral toxoplasmosis lesions. These lesions were commonly located in the brainstem and basal ganglia. Logistic regression showed that the adjusted odds of death significantly decreased by 60% after the first 3 days of hospitalization (aOR = 0.4, 95% CI: 0.16 - 0.6). About two-thirds of patients with cerebral toxoplasmosis died, with most deaths occurring within 72 hours. Efforts are needed to improve early detection of HIV and prompt intervention to reduce the risk of mortality from AHD.