Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was years, and median CD4 count was 49 cells/mm3 (interquartile range (QR): 17–90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality. 1. Introduction HIV infection is a major cause of morbidity and mortality worldwide and affects 33 million people of whom two-thirds live in sub-Saharan Africa [1]. The clinical presentation is diverse and many organ systems are involved. Its predilection for the nervous system makes it neuroinvasive, can enter the central nervous system (CNS), neurotropic, can live in neural tissues and neurovirulent, and can directly cause disease of the nervous system [2, 3]. This complex HIV-nervous system interaction therefore makes neurological manifestations a frequent complication of HIV. Nervous system disease is the main presenting feature in 10–20% of cases, and over 50% of patients with AIDS have neurological disease in the course of HIV disease [4]. It has also been shown that at autopsy 75–90% of HIV patients have neuropathologic abnormalities [4]. Neurological complications in HIV are highly disease stage specific, and this stage specificity largely reflects the dominant influence of altered immune responses especially cell-mediated defences that characterise later phases of systemic infections [5]. Since the introduction of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-associated CNS
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