Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART)

Abstract

Objective-To determine the change of incidence and prevalence of neurological disorders caused by the human immunodeficiency virus (HIV) and opportunistic infections in HIV positive patients under treatment since the introduction of highly active antiretroviral therapy (HAART). Methods-The data of all HIV infected patients were retrospectively analysed, who were examined in the HIV outpatients clinic of the neurological department of the University Clinic Essen between 1995 and 1998 (n=563, total number of visits-=735). Data from identified patients were divided into two groups according to the time of examination from 1995 to 1996 (334 visits) and from 1997 to 1998 (401 visits). The incidence and prevalence of neurological disorders were statistically compared between both time intervals. Results-Significantly more patients received HAART in 1997-8 (p<0.001) and mean CD4+ cell count was significantly higher in 1997-8 (p<0.001). The prevalence of HIV associated dementia and HIV associated polyneuropathy were significantly lower in 1997-8 (both: p=0.02) and the incidence of toxoplasma encephalitis decreased from 5.7% in 1995-6 to 2.2% in 1997-8 (p=0.015). Based on the small number of patients significant changes in HIV associated myopathy, progressive multifocal leukoencephalopathy, cryptoccocal meningitis, and cytomegalovirusencephalitis could not be detected. Conclusion-The prevalence of the most frequent HIV associated neurological disorders and incidence of toxoplasma encephalitis decreased since the introduction of HAART. This may be due to the improvement of immunostatus by HAART as demonstrated by the higher CD4+ cell count in the later time interval. Direct antiretroviral eVects within the nervous system may be considered causative as well. The prevalence and incidence of HIV associated neurological disorders and opportunistic CNS infections decreased after introduction of HAART.

Parkinsonism and AIDS: a clinical comparative study before and after HAART

“…This fact has also been observed in the literature [3][4][5][6] . Currently HAART consists of four classes of drugs: nucleoside reverse transcriptase inhibitors and nucleotide analogs (NRTIs) (Lamivudine, Zalcitabine, Zidovudine, Didanosine, Tenofovir, Stavudine and Abacavir); non-nucleoside reverse transcriptase inhibitors (NNRTIs) (Delavirdine, Efavirenz and Nevirapine); protease inhibitors (PIs) (Indinavir, Saquinavir, Ritonavir, Atazanavir and Nelfinavir) and fusion inhibitors 7 .…”

3D pattern of brain atrophy in HIV/AIDS visualized using tensor-based morphometry

“…HAART restores immune function, reducing opportunistic infections, and has prolonged the median survival period for patients to 44 months in contrast to 6 months in the pre-HAART era (Dore et al, 2003). The prevalence and incidence of HIV-associated dementia have also decreased since HAART was introduced (Maschke et al, 2000;Sacktor et al, 2001). In a cohort study, patients taking HAART for 3 years showed significant improvement in neurocognitive performance, which was associated with the magnitude of CD4 + cell count increases ).…”

Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

“…On the other hand, CSF abnormalities in patients with CMV polyradiculopathy can mimic the pattern of acute bacterial meningitis, including a pleocytosis with polymorphonuclear leucocyte preponderance, a raised protein concentration and hypoglycorrhachia or a reduced CSF:plasma glucose ratio 24,25 . Some studies reported 50-76% of patients with CMV poliradiculopathy and "typical" polymorphonuclear preponderant pleocytosis 21 . In our study we confirm a broad spectrum of CSF patterns in CMV polyradiculopathy.…”

“…Clinical studies performed in developed countries in the HAART era reported a prevalence of CMV encephalitis < 2% 21 . Similar figures have been reported in hospital-based studies in Brazil 28,33 .…”