New-onset seizures as an initial presentation of end-stage renal failure in patients with HIV/AIDS

We present 2 patients with HIV/AIDS and suspected HIV-associated nephropathy who presented with end-stage renal disease and new-onset seizures. These cases highlight the relationship between metabolic disorders and new-onset seizures in HIV-infected persons. Causes of new-onset seizures in this setting include opportunistic infections, HIV-associated dementia (AIDS dementia complex), and various metabolic disorders. A sizable proportion of patients had no identifiable cause of seizures despite extensive workup. In these instances, seizures can be attributed to subclinical effects - direct and indirect - of HIV on the brain. Seizures tended to be recurrent, sometimes despite anticonvulsant therapy. In a subset of patients, seizures were the initial presenting sign of HIV infection.