DIAGNOSTIC LUMBAR PUNCTURE IN HIV-INFECTED PATIENTS - ANALYSIS OF 138CASES

PURPOSE: This study was designed to describe the cerebrospinal fluid ( CSF) findings and neurologic diagnoses observed in human immunodeficie ncy virus (HIV)-infected adults undergoing diagnostic lumbar puncture (LP) and to correlate the results of LP with indications and CD4 count s. DESIGN: Retrospective cross-sectional chart review study. SETTING: University hospital clinic for patients with HIV infection. PATIENTS: All patients of the University of California, San Francisco (UCSF) AID S Clinic who underwent LP between mid-1987 and mid-1990 for headache, fever, altered mental status, or a combination of these indications. S ixty-seven percent had an AIDS diagnosis at the time of LP; the median CD4 count was 0.091 x 10(9)/L. RESULTS: A total of 138 LPs was analyz ed. Elevation of CSF protein and leukocytes occurred in 33% and 27% of specimens, respectively. Seventy-two new neurologic diagnoses were es tablished in 67 patients, but only 30 diagnoses were the result of CSF analysis. Of these 30 diagnoses, 18 were of aseptic meningitis attrib uted to HIV. None of the 12 treatable diagnoses established by LP occu rred in patients known to have a CD4 count of 0.200 x 10(9)/L or great er. Patients undergoing LP because of headache had a lower incidence o f new diagnoses than those with altered mental status (35% versus 72%) , but LP revealed a higher proportion of diagnoses in the up with head ache. CONCLUSIONS: CSF abnormalities were common at all stages of dise ase. LP was diagnostic in 22% of cases, but fewer than half of the dia gnoses were of treatable secondary complications. Patients with a CD4 count higher than 0.200 x 10(9) have a very low incidence of opportuni stic complications. The relatively low yield of LP in patients with al tered mental status suggests that other testing modalities should be u sed prior to LP.