Background: Guillain-Barre syndrome (GBS) has been reported in HIV-positive individuals, but the incidence and characteristics in this group of patients has not systematically been investigated beyond case reports and retrospective series. The aim of this study was to compare the incidence and characteristics of GBS in HIV positive and -negative individuals. Methods: We performed a prospective, comparative study over a 3 ½ year period in the Western Cape province of South Africa. All adult patients with GBS were included and classified into 2 groups based on HIV status. The two groups were compared with regards to clinical, electrophysiological and laboratory features. Patients were followed until stable or recovered, for a maximum of 12 months. Results: 28 patients were included in the study, of which 15 were HIV-positive. Using estimated HIV prevalence data for the same geographical area during the study period, the incidence of GBS in HIV-positive patients was calculated to be 18.74, 95% CI [7.69, 40.60] times higher than in HIV-negative patients. Except for the frequency of hyponatraemia, there were no statistically significant differences between the 2 groups with regards to presenting features, severity of illness, GBS subtypes, and treatment response. GBS occurred in all stages of HIV infection, and was the presenting feature of HIV infection in 13 patients. Interpretation: The incidence of GBS is strikingly increased in HIV infection. The reason for this is still uncertain, but can probably be explained by immune dysregulation. HIV infection does not appear to influence the short term outcome of GBS.
