Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Epilepsy Behav. 2019 Apr;93:49-55. doi: 10.1016/j.yebeh.2019.01.033. Epub 2019 Mar 1.
The prevalence and incidence of seizures are substantially higher in patients with human immunodeficiency virus (HIV) compared with the general population and is associated with higher mortality rates. Despite this, the condition remains poorly understood, and there is variation in reported epidemiological studies. The aim of this systematic review and meta-analysis was to investigate the risk factors associated with seizures in the population with HIV, explore the source of variations, and describe management plans that can aid clinicians in the acute and long-term treatment of these patients.
A structured electronic database search of MEDLINE, EMBASE, and Cochrane Library was conducted. Studies were included if they described clinical details of patients with HIV with seizures or epilepsy. We extracted select variables from each included study, and we estimated pooled estimates of the incidence and prevalence of seizures using random-effects meta-analysis of proportions.
Information on 6639 cases of patients with HIV was extracted from 9 included studies. These comprised of 2 studies from the United States of America (USA), 3 from Europe, 3 from Asia, and 1 from Africa. The pooled prevalence and incidence rate of seizures in HIV were 62 per 1000 population and 60 per 1000 population respectively. Among those who presented with new-onset seizures, 63% had seizure recurrence. At the time of first seizure, 82.3% had acquired immunodeficiency syndrome (AIDS). Factors that appeared to be linked to seizures in HIV included advanced HIV disease, opportunistic infections particularly toxoplasmosis, and metabolic derangement. Most seizures were effectively controlled by common antiepileptic drugs (AEDs).
The prevalence and incidence of seizures and epilepsy in the population with HIV are substantially higher than the general population. Our results suggest that advanced HIV and opportunistic infections are associated with the majority of the seizures. Early initiation of highly active antiretroviral therapy (HAART), prophylactic use of cotrimoxazole (trimethoprim-sulfamethoxazole) and routine electroencephalogram (EEG) in patients with HIV may reduce seizure incidence and frequency and help in early diagnosis of nonconvulsive seizures in this population. We recommend long-term seizure management with AED, and for patients on HAART, enzyme-inducing AED should be avoided when possible.
与普通人群相比，人类免疫缺陷病毒（HIV）感染者的癫痫发作患病率和发病率显著更高，且与之相关的死亡率也更高。尽管如此，该疾病仍未被充分认识，并且在报告的流行病学研究中存在差异。本系统评价和荟萃分析的目的是调查与 HIV 感染者癫痫发作相关的危险因素，探讨变异的来源，并描述可帮助临床医生对这些患者进行急性和长期治疗的管理计划。
对 MEDLINE、EMBASE 和 Cochrane Library 进行了结构化电子数据库检索。如果研究描述了 HIV 伴发癫痫或癫痫发作的患者的临床详细信息，则将其纳入研究。我们从每项纳入研究中提取了选择变量，并使用随机效应荟萃分析比例来估计癫痫发作的发病率和患病率的汇总估计值。
从 9 项纳入研究中提取了 6639 例 HIV 患者的信息。这些研究包括来自美国的 2 项研究、来自欧洲的 3 项研究、来自亚洲的 3 项研究和来自非洲的 1 项研究。HIV 患者癫痫发作的患病率和发病率分别为 62/1000 人群和 60/1000 人群。在新发癫痫发作患者中，63%的患者出现了癫痫复发。在首次癫痫发作时，82.3%的患者患有获得性免疫缺陷综合征（AIDS）。似乎与 HIV 相关的癫痫发作的因素包括晚期 HIV 疾病、机会性感染（特别是弓形虫病）和代谢紊乱。大多数癫痫发作通过常见的抗癫痫药物（AEDs）得到有效控制。
HIV 感染者癫痫发作和癫痫的患病率和发病率明显高于普通人群。我们的研究结果表明，晚期 HIV 和机会性感染与大多数癫痫发作有关。早期启动高效抗逆转录病毒治疗（HAART）、对 HIV 患者预防性使用复方磺胺甲噁唑（trimethoprim-sulfamethoxazole）和常规脑电图（EEG）可能会降低癫痫发作的发生率和频率，并有助于早期诊断该人群中的非惊厥性癫痫发作。我们建议对癫痫进行长期的药物治疗管理，对于接受 HAART 的患者，应尽可能避免使用酶诱导的 AED。
