Pathogenic characteristics of central nervous system infections in AIDS individuals: a retrospective cohort study based on immune status

Background Human immunodeficiency virus (HIV) infection frequently leads to central nervous system (CNS) complications, especially as immunity declines. While antiretroviral therapy (ART) has transformed HIV into a manageable condition, in clinical practice, a significant subset of individuals still present with advanced immunosuppression (CD4 Methods We retrospectively analyzed 213 individuals with AIDS who presented with CNS symptoms and confirmed CNS infections. They were grouped by CD4 count: 101 with ≥200 cells/μL (Moderate to High Immune, HI) and 112 with Results Individuals with low CD4 counts showed significantly more severe symptoms like altered consciousness (50.00% vs. 31.68%, p = 0.007) and seizures (25.00% vs. 12.87%, p = 0.025). Their CSF tests revealed higher white blood cell counts (30.72 ± 8.50 vs. 18.32 ± 4.41 cells/μL, p p p p p p Cryptococcus neoformans (49.11% vs. 22.77%, p Mycobacterium tuberculosis (MTB) (18.75% vs. 7.92%, p = 0.021), and Cytomegalovirus (CMV) (15.18% vs. 5.94%, p = 0.030), were much more common in the LI group. Individuals in the MHI group achieved complete remission more often (66.34% vs. 51.79%, p = 0.031) and had less disease progression (9.90% vs. 21.42%, p = 0.022). Their quality of life scores after treatment for the CNS infection were also significantly better across physical, psychological, social, and overall health domains ( p p Conclusion This study quantifies the severe impact of advanced immunosuppression (CD4 < 200 cells/μL) on CNS infection presentation, short-term treatment response (for CNS infections), and quality of life at discharge. Preventing immune decline below this threshold is critical.