A Cohort Study of Seizures and Epilepsy in HIV+ Zambian Adults

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DESCRIPTION (provided by applicant): Seizures are among the most common neurologic events that occur among people with HIV, but there is little epidemiologic data available to guide clinical decision-making regarding whether or when to initiate long term antiepileptic drug (AED) treatment for HIV+ individuals who experience a first seizure. In Zambia, where epilepsy and AIDS prevalence rates are both high and only enzyme-inducing AEDs are routinely available, the risk of interactions between AEDs and antiretroviral medications (ARVs) is especially concerning. This Zambian-based prospective cohort study of HIV+ adults who have experienced new onset seizure will provide important insights into seizure recurrence rates and risk factors for future seizures in people with HIV/AIDS. Knowledge gained from this work will assist clinicians in determining when/whether to initiate chronic treatment for seizures. This project will also expand the capacity for epidemiologic studies of neurologic disorders among people with HIV/AIDS in Zambia and lay the groundwork for the conduct of future research aimed at determining whether the co-usage of enzyme-inducing AEDs and ARVs predispose patients to ARV drug failure and potentially increase the risk of drug resistant HIV. PUBLIC HEALTH RELEVANCE: As antiretroviral treatments become broadly available in Africa, HIV is evolving from a fatal infection into a chronic condition. Caring for people with HIV/AIDS who also suffer from other chronic health conditions, such as epilepsy, is challenging because clinicians do not have sufficient knowledge to know what treatments are best when these disorders co-occur. This prospective study of HIV+ Zambian adults will provide us with important insights into when chronic treatment for seizure prevention is needed and develop the research expertise and foundational knowledge to determine, in future studies, whether combining antiretroviral medications with the older generation epilepsy medications still used in most resource poor settings increases the risk of antiretroviral drug failure.