AUTHOR=de Melo Sabrina Araújo , Pinto Sérgio Damasceno , Ferreira Ewerton da Silva , Brotas Reinan , Marinho Eveny Perlize Melo , da Silva Valderjane Aprigio , Monte Rossiclea Lins , Feitoza Pablo Vinícius Silveira , Reis Monique Freire , Almeida Taynná V. Rocha , Ferreira Luiz Carlos de Lima , Bastos Michele de Souza TITLE=Molecular diagnosis of opportunistic infections in the central nervous system of HIV-infected adults in Manaus, Amazonas JOURNAL=Frontiers in Medicine VOLUME=10 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1298435 DOI=10.3389/fmed.2023.1298435 ISSN=2296-858X ABSTRACT=Background

Opportunistic infections in the central nervous system (CNS) of people with HIV/AIDS (PLWHA) remain significant contributors to morbidity and mortality, especially in resource-limited scenarios. Diagnosing these infections can be challenging, as brain imaging is non-specific and expensive. Therefore, molecular analysis of cerebrospinal fluid (CSF) may offer a more accurate and affordable method for diagnosing pathogens.

Methods

We conducted extensive real-time PCR testing (qPCR) on CSF to evaluate etiological agents in PLWHA with neurological manifestations. Primers targeting DNA from specific pathogens, including cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein–Barr virus (EBV), John Cunningham virus (JCV), Toxoplasma gondii, and human T-lymphotropic virus types 1 and 2 (HTLV-1 and HTLV-2), were used.

Results

Cerebrospinal fluid samples revealed 90 pathogens (36.7%). Toxoplasma gondii was the most frequently detected pathogen, found in 22 samples (30.5%). Other pathogens included Cryptococcus sp. (7.7%), EBV (5.3%), CMV, VZV, and JCV (4.0% each).

Conclusion

Despite antiretroviral therapy and medical follow-up, opportunistic central nervous system infections remain frequent in PLWHA. Herpesviruses are commonly detected, but T. gondii is the most prevalent opportunistic pathogen in our study population. Therefore, molecular diagnosis is a crucial tool for identifying opportunistic infections, even in patients undergoing treatment.