New-Onset Seizures in HIV Patients on Antiretroviral Therapy at a Tertiary Centre in South-West, Nigeria


Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life.

Share and Cite:

O. Olajumoke, A. Akinsegun, O. Njideka, O. Oluwadamilola, O. Olaitan, D. Adedoyin, A. Adewumi, D. Akinola and A. Sarah, "New-Onset Seizures in HIV Patients on Antiretroviral Therapy at a Tertiary Centre in South-West, Nigeria," World Journal of AIDS, Vol. 3 No. 2, 2013, pp. 67-70. doi: 10.4236/wja.2013.32009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Kellinghaus, C. Engbring, S. Kovac, G. Moddel, F. Boesebeck, M. Fischera, et al., “Frequency of Seizures and Epilepsy in Neurological HIV-Infected Patients,” Seizure: European Journal of Epilepsy, Vol. 17, No. 1, 2008, pp. 27-33. doi:10.1016/j.seizure.2007.05.017
[2] D. Holtzman, D. Kaku and Y. So, “New-Onset Seizures Associated with HIV Infection: Causation and Clinical Features in 100 Cases,” American Journal of Medicine, Vol. 87, No. 2, 1989, pp. 173-177. doi:10.1016/S0002-9343(89)80693-X
[3] W. Van Paesschen, C. Bodian and H. Maker, “Metabolic Abnormalities and New-Onset Seizures in Human Immunodeficiency Virus-Seropositive Patients,” Epilepsia, Vol. 36, No. 2, 1995, pp. 146-150. doi:10.1111/j.1528-1157.1995.tb00973.x
[4] G. J. Dore, M. G. Law and B. J. Brew, “Prospective Analysis of Seizures Occurring in Human Immunodeficiency Virus Type-1 Infection,” Journal of Neuro-AIDS, Vol. 1, No. 4, 1996, pp. 59-69. doi:10.1300/J128v01n04_06
[5] B. Navia, B. Jordan and R. Price, “The AIDS Dementia Complex: I Clinical Features,” Annals of Neurology, Vol. 19, No. 6, 1986, pp. 517-524. doi:10.1002/ana.410190602
[6] M. Modi, A. Mochan and G. Modi, “New Onset Seizures in HIV—Seizure Semiology, CD4 Counts, and Viral Loads,” Epilepsia, Vol. 50, No. 5, 2009, pp. 1266-1269. doi:10.1111/j.1528-1167.2008.01942.x
[7] B. Pascual-Sedano, A. Iranzo, J. Marti-Fabregas, et al., “Prospective Study of New-Onset Seizures in Patients with HIV Infection: Etiologic and Clinical Aspects,” Archives of Neurology, Vol. 56, No. 5, 1999, pp. 609-612. doi:10.1001/archneur.56.5.609
[8] J. M. Provenzale and J. R. Jinkins, “Brain and Spine Im-aging Findings in AIDS Patients,” Radiologic Clinics of North America, Vol. 35, 1997, pp. 1127-1166.
[9] D. J. Farrar, T. P. Flanigan, N. M. Gordon, R. L. Gold and J. D. Rich, “Tuberculous Brain Abscess in a Patient with HIV Infection: Case Report and Review,” American Journal of Medicine, Vol. 102, No. 3, 1997, pp. 297-301. doi:10.1016/S0002-9343(97)00386-0
[10] C. Martinez-Vazquez, J. Bordon, A. Rodriguez-Gonzalez, et al., “Cerebral Tuberculoma-Acomparative Study in Patients with or without HIV Infection,” Infection, Vol. 23, No. 3, 1995, pp. 49-53. doi:10.1007/BF01793855
[11] A. N. Mamelak, W. G. Obana, J. F. Flaherty and M. L. Rosenblum, “Nocardial Brain Abscess: Treatment Strategies and Factors Influencing the Outcome,” Neurosurgery, Vol. 35, No. 4, 1994, pp. 622-631. doi:10.1227/00006123-199410000-00007
[12] D. R. Labar, “Seizures and HIV Infection,” In: T. A. Pedley and B. S. Meldrum, Eds., Recent Advances in Epilepsy, Churchill Livingstone, Edinburgh, 1992, pp. 119-126.
[13] F. Bartolomei, M. Gavaret, C. Dhiver, et al., “Isolated, Chronic, Epilepsia Partialis Continua in an HIV-Infected Patient,” Archives of Neurology, Vol. 56, No. 1, 1999, pp. 111-114. doi:10.1001/arch neur.56.1.111
[14] D. S. Chadha, A. Handa, S. K. Sharma, P. Varadarajulu and A. P. Singh, “Seizures in Patients with Human Immunodeficiency Virus Infection,” Journal of the Association of Physicians, Vol. 48, 2000, pp. 573-576.
[15] P. Mullin, G. Green and R. Bakshi, “Special Populations: the Management of Seizures in HIV-Positive Patients,” Current Neurology and Neuroscience Reports, Vol. 4, No. 4, 2004, pp. 308-314. doi:10.1007/s11910-004-0057-x
[16] P. W. Hugen, D. M. Burger, K. Brinkman, H. J. ter Hofstede, R. Schuurman, P. P. Koopmans, et al., “Carbamazepine—Indinavir Interaction Causes Antiretroviral Therapy Failure,” Annals of Pharmacotherapy, Vol. 34, No. 4, 2000, pp. 465-470. doi:10.1345/aph.19211
[17] M. Barry, S. Gibbons, D. Back and F. Mulcahy, “Protease Inhibitors in Patients with HIV Disease. Clinically Important Pharmacokinetic Considerations,” Clinical Pharmacokinetics, Vol. 32, No. 3, 1997 pp. 194-209. doi:10.2165/00003088-199732030-00003
[18] M. D. Liedtke, S. M. Lockhart and R. C. Rathbun, “Anticonvulsant and Antiretroviral Interactions,” Annals of Pharmacotherapy, Vol. 38, No. 3, 2004, pp. 482-489. doi:10.1345/aph.1D309
[19] G. L. Birbeck, J. A. French, E. Peruca, D. M. Simpson, H. Fraimow, J. M. George, et al., “Evidence-Based Guideline: Antiepileptic Drug Selection for People with HIV/ AIDS. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy,” Neurology, Vol. 78, No. 2, 2012, pp. 139-145.
[20] M. C. Wong, N. D. A. Suite and D. R. Labar, “Seizures in Human Immunodeficiency Virus Infection,” Archives of Neurology, Vol. 47, No. 6, 1990, pp. 640-642. doi:10.1001/archneur.1990.005300 60048015
[21] A. Millogo, D. Lankoandé, I. Yaméogo, A. A. Yaméogo, A. Sawadogo and A. B. Sawadogo, “New-Onset Seizures in Patients with Immunodeficiency Virus Infection in Bobo-Dioulasso Hospital (Burkina Faso),” Bulletin de la Société de Pathologie Exotique, Vol. 97, No. 4, 2004, pp. 268-270.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.