title: HIV and new onset seizures: slipping through the cracks in HIV care and treatment.
abstract: OBJECTIVE
  The aim of the study was to describe patient characteristics and outcomes among HIV-positive adults presenting to a Zambian tertiary care hospital with new-onset seizures.
  
  
  METHODS
  From July 2011 to June 2013, adults with seizures and a known or probable diagnosis of HIV infection were screened for a cohort study. Demographic and clinical data were obtained, including information on engagement in HIV services and in-patient mortality. Analyses were conducted to identify characteristics associated with poor engagement in care and death.
  
  
  RESULTS
  A total of 320 of 351 screened adults were HIV-positive, with 268 of 320 experiencing new-onset seizures. Of these, 114 of 268 (42.5%) were female, and their mean age was 36.8 years. Seventy-nine of the 268 patients (29.5%) were diagnosed with HIV infection during the index illness. Among those who were aware of their HIV-positive status, 59 of 156 (37.8%) had disengaged from care. Significant functional impairment (Karnofsky score < 50) was evident in 44.0% of patients. Cerebrospinal fluid was not obtained in 108 of 268 (40.3%). In-patient mortality outcomes were available for 214 patients, and 47 of these 214 (22.0%) died during hospitalization. Patients with significant functional impairment were more likely to undergo lumbar puncture (P = 0.046). Women and the functionally impaired were more likely to die (P = 0.04 and < 0.001, respectively).
  
  
  CONCLUSIONS
  Despite the availability of care, less than half of HIV-infected people with new-onset seizures were actively engaged in care and in-patient mortality rates were high. In the absence of clinical contraindication, lumbar puncture should be performed to diagnose treatable conditions and reduce morbidity and mortality. Continued efforts are needed to expand community-based testing and improve HIV care retention rates. Qualitative studies are needed to elucidate factors contributing to lumbar puncture usage in this population.
authors.affiliation: HIV Prevention, Care and Treatment Program, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
authors.forename: I
authors.initials: I
authors.lastname: Sikazwe
authors.affiliation: College of Human Medicine, Michigan State University (MSU), East Lansing, MI, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Elafros
authors.affiliation: Greater Lawrence Family Health Center, Lawrence, MA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Bositis
authors.affiliation: Global Neurology Center, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Center for Virology and Vaccine Research, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Internal Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: O K
authors.initials: OK
authors.lastname: Siddiqi
authors.affiliation: Global Neurology Center, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Center for Virology and Vaccine Research, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: I J
authors.initials: IJ
authors.lastname: Koralnik
authors.affiliation: Department of Psychology, University of Zambia (UNZA), Lusaka, Zambia.
authors.forename: L
authors.initials: L
authors.lastname: Kalungwana
authors.affiliation: Clinical Epilepsy Unit, United States National Institutes of Health (US NIH), Bethesda, MD, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Theodore
authors.affiliation: HIV Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Okulicz
authors.affiliation: Department of Imaging Sciences, University of Rochester, Rochester, NY, USA.|Lusaka Apex Medical School, Medical Radiation Sciences, Lusaka, Zambia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Potchen
authors.affiliation: Department of Neurology, University of Rochester, Rochester, NY, USA.|Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.
authors.forename: G L
authors.initials: GL
authors.lastname: Birbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D002452:Cell Count; D002648:Child; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012640:Seizures / Q000134:cerebrospinal fluid / Q000209:etiology / Q000401:mortality / Q000821:virology*; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D019562:Viral Load; D015024:Zambia / Q000453:epidemiology
keywords: HIV; cerebrospinal fluid; consent; epilepsy; missed opportunities