Highly active antiretroviral therapy access and neurological complications of human immunodeficiency virus infection: Impact versus resources in Brazil

Abstract

Currently, there are almost 600,000 human immunodeficiency virus (HIV)-infected individuals in Brazil. From 1984 to 2004, 362,364 acquired immunodeficiency virus (AIDS) cases were officially reported and 155,000 patients are under highly active antiretroviral therapy (HAART) treatment. Like in developed countries, universal access to treatment in Brazil has definitively changed both mortality and morbidity of AIDS. Today, the median survival time is 58 months, with a 2-year survival of 63%, versus 18 months before HAART. As expected, the incidence of nervous system opportunistic infectious diseases and tumors has also decreased in Brazil. However, few Brazilian reports about neurological manifestations of HIV infection are available, particularly after the beginning of more effective antiretroviral therapy. Autopsy series report that toxoplasmosis is the most prevalent neurological disease, followed by cryptococcosis and HIV encephalitis. A much lower incidence of progressive multifocal leukoencephalopathy has been described in Brazil than in reports from developed countries. A possibility for this discrepancy could be differences in terms of JC virus (JCV) isolates or even the interactions between JCV and local HIV strains. Some particularities about the involvement of the nervous system in Brazilian patients are worthy of note, such as the occurrence of central nervous system involvement in chronic Chagas' disease in patients with AIDS, and the concomitance of leprosy and HIV infection. National surveillance of neurological manifestations of HIV infection is needed to ascertain the real impact of HAART on nervous system diseases associated with AIDS in Brazil.

Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

“…HAART has significantly reduced secondary reactivation and relapse in cases of toxoplasmosis and has improved survival in these HIV-infected patients. This is certainly due to the successful suppression of virus replications followed by an increase in CD4 + lymphocytes, a partial recovery of T-cell specific immune responses and decreased susceptibility to both local and systemic opportunistic pathogens129. The IRIS constitutes a clinical deterioration of OIs in HIV-infected patients as a result of the enhancement of pathogen-specific immune responses due to the use of HAART.…”

The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006

“…Central nervous system infections, as opportunistic infections in general, declined substantially in the post-HAART era. Notwithstanding, some infections such as cerebral toxoplasmosis, Cryptococcus neoformans meningitis, HIV encephalitis, and central nervous system tuberculosis are still relatively common 67,68,69,70 , sometimes as an AIDS-defining disease of people living with HIV or a first manifestation of immunodeficiency among patients previously unaware of their serostatus 71 . A distinctive characteristic of neurological complications of HIV infection in Brazil is the much lower incidence of progressive multifocal leukoencephalopathy compared with developed countries, probably due to local characteristics of human polyomavirus JC (JCV) isolates and/or their interaction with co-circulating HIV strains 69 .…”

Toxoplasmosis in HIV/AIDS Patients - A Living Legacy

“…HAART has reduced relapse in cases of toxoplasmosis and has improved survival in these HIV-infected patients. This may be due to the successful suppression of virus replications followed by an increase in CD4+ lymphocytes, a partial recovery of T-cell specific immune responses and decreased susceptibility to both local and systemic opportunistic pathogens (Silva & Araújo, 2005). HIV-associated IRIS is the clinical worsening of opportunistic infections that result from enhancement of pathogen-specific immune responses among patients responding to antiretroviral treatment (Lawn & Wilkinson, 2006).…”