Prevalence and incidence of new-onset seizures and epilepsy in patients with human immunodeficiency virus (HIV): Systematic review and meta-analysis

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)49-55
Number of pages7
JournalEpilepsy and Behavior
Volume93
DOIs
StatePublished - Apr 1 2019

Fingerprint

Meta-Analysis
Epilepsy
Seizures
HIV
Incidence
Population
Anticonvulsants
Opportunistic Infections
Highly Active Antiretroviral Therapy
Virus Diseases
Toxoplasmosis
Sulfamethoxazole Drug Combination Trimethoprim
MEDLINE
Libraries
Epidemiologic Studies
Early Diagnosis
Electroencephalography
Acquired Immunodeficiency Syndrome
Databases

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

Cite this

@article{18fa9065c777454da93df4fe996b1f9b,
title = "Prevalence and incidence of new-onset seizures and epilepsy in patients with human immunodeficiency virus (HIV): Systematic review and meta-analysis",
abstract = "Background: 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. Methods: 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. Results: 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). Conclusions: 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.",
author = "Paddy Ssentongo",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.yebeh.2019.01.033",
language = "English (US)",
volume = "93",
pages = "49--55",
journal = "Epilepsy and Behavior",
issn = "1525-5050",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Prevalence and incidence of new-onset seizures and epilepsy in patients with human immunodeficiency virus (HIV)

T2 - Systematic review and meta-analysis

AU - Ssentongo, Paddy

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=85062167682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062167682&partnerID=8YFLogxK

U2 - 10.1016/j.yebeh.2019.01.033

DO - 10.1016/j.yebeh.2019.01.033

M3 - Review article

C2 - 30831402

AN - SCOPUS:85062167682

VL - 93

SP - 49

EP - 55

JO - Epilepsy and Behavior

JF - Epilepsy and Behavior

SN - 1525-5050

ER -