What are the challenges presented by new-onset seizures in HIV?

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The global prevalence of HIV is estimated to be 0.8%with 46% of new HIV infections occurring in sub-Saharan Africa in 2015 [1]. Seizures are a common manifestation of neurological disease in HIV positive patients. Individuals with HIV may present with new-onset seizures as a result of an acute infectious etiology, a brain injury due to long-standing HIV with its associated inflammatory process (i.e., HIV encephalopathy), or a toxic-metabolic challenge related to infections or adverse drug reactions. Importantly, regions with high epilepsy prevalence rates may overlap substantially with HIV endemicity so the co-occurrence of epilepsy and HIV should be expected even if the two conditions are not biologically linked.

Evaluating HIV positive patients with new-onset seizure presents many challenges and the nature of these challenges vary based upon the resources available within the care setting. Special consideration should be given to relevant characteristics of the local patient population. Cultural factors, particularly the stigma associated with seizures, may play a vital role in healthcare seeking behavior, acceptance of the condition and adherence to antiepileptic drugs (AEDs). Fear of epilepsy and epilepsy-associated stigma may predispose individuals with newly-diagnosed HIV to also experience greater HIV-associated stigma [2].

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Author Affiliations

Allison Navis 1, Manoj Mathew 2, 3, Gretchen L. Birbeck 4, 5

1 Department of Neurology, Icahn School of Medicine, Beth Israel Medical Center, New York, NY, USA 2 University Teaching Hospitals, Lusaka Children’s Hospital, Lusaka, Zambia 3 University of Zambia School of Medicine, Lusaka, Zambia 4 Chikankata Epilepsy Care Team, Mazabuka, Zambia 5 Strong Epilepsy Center, Department of Neurology, University of Rochester, Rochester, NY, USA

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