Background: CSF PCR is the standard diagnostic technique used in resource-rich settings to detect pathogens of\nthe CNS infection. However, it is not currently used for routine CSF testing in China. Knowledge of CNS opportunistic\ninfections among people living with HIV in China is limited.\nMethods: Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral and fungal etiologies.\nPathogen-specific primers were used to detect DNA from cytomegalovirus (CMV), herpes simplex virus (HSV),\nvaricella-zoster virus (VZV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6) and John Cunningham virus (JCV)\nvia real-time polymerase chain reaction (PCR).\nResults: Cryptococcal meningitis accounted for 63.0% (34 of 54) of all causes of meningitis, 13.0% (7/54) for TB, 9.3%\n(5/54) for Toxoplasma gondii. Of 54 samples sent for viral PCR, 31.5% (17/54) were positive, 12 (22.2%) for CMV, 2 (3.7%)\nfor VZV, 1 (1.9%) for EBV, 1 (1.9%) for HHV-6 and 1 (1.9%) for JCV. No patient was positive for HSV. Pathogen-based\ntreatment and high GCS score tended to have a lower mortality rate, whereas patients with multiple pathogens infection,\nseizures or intracranial hypertension showed higher odds of death.\nConclusion: CNS OIs are frequent and multiple pathogens often coexist in CSF. Cryptococcal meningitis is the most\nprevalent CNS disorders among AIDS. The utility of molecular diagnostics for pathogen identification combined with\nthe knowledge provided by the investigation may improve the diagnosis of AIDS related OIs in resource-limited\ndeveloping countries, but the cost-efficacy remains to be further evaluated.
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