Transverse Comparison of Clinical Characteristics and Prognostic Factors in HIV-Infected Patients with Cytomegalovirus Encephalitis in Guangdong, China.

introductionCytomegalovirus encephalitis (CME) is one of the serious opportunistic complications in human immunodeficiency virus (HIV)-infected patients, characterized by rapid onset, poor prognosis, and high mortality. Until now, there has been limited comprehensive research on the clinical and prognostic characteristics of HIV/CME patients reported in China.

methodsWe conducted a retrospective study of 43 patients diagnosed with CME among individuals infected with HIV from 2015 to 2023 at Guangzhou Eighth People's Hospital. Among them, 27 patients had a favorable prognosis, while 16 patients had an unfavorable prognosis (which includes death, treatment ineffectiveness, or aggravated condition), as determined by clinical diagnosis. The clinical symptoms and laboratory examination data for the two groups were analyzed. Multivariate analysis and a nomogram were developed using statistical variables.

resultsHIV/CME patients with an unfavorable prognosis exhibited more consciousness disorders and nuchal rigidity than those with a favorable prognosis. There were no significant differences between the two groups in terms of clinical characteristics, such as hemiparalysis, meningeal irritation, cerebrospinal fluid (CSF) pressure, and other relevant factors. In the CSF, the chloride (Cl) level was significantly higher in HIV/CME patients with a favorable prognosis, whereas the Cytomegalovirus (CMV)-DNA levels showed the opposite trend. A multivariate analysis of fever, nuchal rigidity, consciousness disorder, and CSF CMV-DNA can be used to predict prognosis in HIV/CME patients, with a C-index of 0.83 (95% CI: 0.64-1.00). The log CSF CMV-DNA copies/mL emerged as an independent risk factor for prognosis. High CSF CMV-DNA (≥300,000 copies/mL) indicated an unfavorable prognosis. This study is the first to propose a prognostic threshold for CSF CMV-DNA (≥300,000 copies/mL) and develop a nomogram that integrates clinical and laboratory features for risk prediction in HIV/CME patients in China. DISCUSSION: The findings highlight that CSF CMV-DNA ≥ 300,000 copies/mL, along with neurological symptoms such as consciousness disorder and nuchal rigidity, are significant predictors of unfavorable prognosis in HIV/ CME patients. The constructed nomogram offers a clinically useful tool for early risk stratification, which may aid in timely therapeutic decision-making.

conclusionHIV/CME patients with an unfavorable prognosis showed more obvious signs and symptoms of central nervous system infection, lower CSF Cl levels, and higher CSF CMV-DNA compared to patients with a favorable prognosis. Recognizing these indicators early and administering timely antiviral therapy before the disease progresses to CME are of great value in improving the survival rate of patients. Our findings extend beyond existing international studies by providing novel prognostic evidence in a Chinese cohort and offering a practical predictive tool for clinical risk stratification.