Compare clinical characteristics and outcomes between people with HIV (PWH) and neurocysticercosis (NCC)  and HIV-uninfected adults with NCC.

Neurocysticercosis (NCC) is a parasitic disease of the central nervous system caused by Taenia solium, commonly presenting with seizures. It is endemic in Zambia which also has a high rate of HIV. Whether or not HIV has an influence on the presentation and outcome of NCC is unknown.

A prospective longitudinal cohort study of adults (>18 years) diagnosed with NCC at the University Teaching Hospital in Lusaka, Zambia was conducted between December 2021 and October 2023. The diagnosis of NCC was made on routine head CT or MRI. Interviews and chart reviews of consenting participants were conducted to obtain HIV status, clinical features and vital status at discharge. Vital status and seizure status were obtained by follow-up phone interviews at 12 months post-discharge.

During the study period, 71 participants were recruited, of whom 17% (n=12) were PWH. The mean age of PWH was 47 (SD16) years compared to 38 (SD12) years among HIV-uninfected participants (p=0.03). Twelve-month follow-up data were available in 49 (69%) of participants, including 11 (92%) of PWH and 38 (64%) of HIV-uninfected participants.   Twelve-month mortality was 36% (n=4/11) among PWH and 3% (n=1/38) among participants without HIV (p=0.007). There were no other significant differences in demographic, radiological, or clinical characteristics between PWH and participants without HIV.

Mortality is significantly higher in PWH and NCC than in HIV-uninfected adults with NCC in Zambia, and NCC occurs at older ages amongst PWH. Whether mortality is due to NCC itself or to other AIDS-related processes requires further investigation.  More work is required to further understand the relationship between HIV and NCC in endemic countries such as Zambia.