Neurological disease: the effects of HIV and antiretroviral therapy and the implications for early antiretroviral therapy initiation

Wright, Edwina

doi:10.1097/coh.0b013e32832dd0c2

Cited by 12 publications

(5 citation statements)

References 54 publications

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“…The risk of death was higher among patients with tuberculosis coinfection whereas getting antiretroviral therapy and being infected with Epstein-Barr virus were associated with lower case fatality. Findings related to ART and tuberculosis are consistent with published research because antiretroviral therapy has a known beneficial effect on the outcomes of HIV-associated neurological complications [24,25]. Tuberculosis remains a risk factor of death among HIV patients, especially in poorer countries [26][27][28].…”

Section: Discussionsupporting

confidence: 85%

Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine

Lytvyn¹,

Шостакович-Корецька²,

Doroshenko³

et al. 2019

HIV & AIDS Review

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Introduction: We aimed to describe the epidemiological, clinical, laboratory characteristics, and outcomes of central nervous system (CNS) mycosis in patients with human immunodeficiency virus (HIV) and to determine characteristics associated with a higher risk of death. Retrospective data from 77 case histories of HIV-infected patients with neurological symptoms caused by various fungi including Candida and Cryptococcus in Dnipro, Ukraine, were analysed as a case-control study with 40 deceased individuals considered as cases and 37 patients with favourable outcome (survivors) considered as controls. Material and methods: Fungi in cerebrospinal fluid (CSF) were detected with traditional culture methods. Multivariate analysis used (1) binary logistic regression with survivor/dead as a dependent variable and (2) a classification and regression tree (CRT method). Results: A combination of fungal infection with other infections of CNS (dual and triple coinfection) was diagnosed in most cases (n = 53, 68.8%), while the proportion of co-infection was somewhat lower among survivors (59.5%). Clinical manifestations were non-specific. Risk of death was higher among those with tuberculosis (AOR = 2.7, 95% CI: 1.0-7.5) and lower among those infected with Epstein-Barr virus (EBV) (AOR = 0.3, 95% CI: 0.1-1.0) and among patients on ART (AOR = 0.2, 95% CI: 0.1-0.8). Risk of death significantly decreased over time. The classification tree shows that among HIV-mycosis neurological patients not on ART with tuberculosis, the risk of death constituted 75%, while among patients on ART with EBV-infection, all patients survived. Conclusions: Opportunistic mycoses remain an important clinical challenge among immuno-compromised patients especially those who were diagnosed with HIV late, failed to get antiretroviral therapy, and developed tuberculosis.

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Section: Discussionsupporting

confidence: 85%

Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine

Lytvyn¹,

Шостакович-Корецька²,

Doroshenko³

et al. 2019

HIV & AIDS Review

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“…The possibility of patients harboring the infection for much longer periods of time than they are aware of should be taken into consideration when interpreting data related to duration of HIV illness. Although untreated disease is a well-known risk factor for AIDS dementia and it is suggested that early initiation of treatment may also result in superior or preserved neurocognitive performance,[ 17 ] our study did not find such an association possibly due to a smaller number of subjects having possible AIDS dementia.…”

Section: Discussioncontrasting

confidence: 82%

Logistic regression-based parametric analysis of HIV-associated dementia using a screening tool in a tertiary care hospital in Mumbai

Joshi

Ambardekar

Gujarathi

et al. 2022

Indian Journal of Sexually Transmitted Diseases and AIDS

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Context: The AIDS dementia complex is one of the most common and clinically important complications of HIV infection. Subclinical dementia not presenting with features of frank disease may be missed. The use of screening tools provides a good alternative to a psychiatrist's diagnosis in resource-limited settings like the site of this study. Aims: The study aimed to analyze various parameters such as age, gender, duration of the disease, duration since treatment, clinical staging, CD4 count, mode of transmission, and comorbidities like tuberculosis with the prevalence of AIDS dementia complex in the participants. Settings and Design: A cross-sectional study involving 180 participants was conducted over a duration of 18 months. Materials and Methods: The assessment of dementia was done using the International HIV Dementia Scale. Statistical Analysis Used: Backward binomial logistics regression. Results: Both duration of treatment and duration since diagnosis of HIV were found to be significantly associated with the presence of AIDS dementia. Patients having stage 4 disease and CD4 counts <200 were likelier to have dementia as compared to other participants. People with an unknown mode of transmission had higher odds of having AIDS dementia than persons having a mode of transmission as via blood/blood products/invasive procedures/mother-to-child transmission/IV drug abuse. Binomial logistic regression revealed mode of transmission or rather its awareness to be the strongest contributor. Conclusions: These findings highlight the need for early screening and diagnosis of HIV-associated dementia in patients living with HIV and that of early assessment and initiation of treatment.

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“…HAART may be neurotoxic (Schweinsburg et al 2005) in particular systemic and peripheral nervous system effects have been well documented (Wright 2009). However, these medications may also affect the brain.…”

Section: Discussionmentioning

confidence: 99%

Effect of HAART on Brain Organization and Function in HIV-Negative Subjects

Brier

Tanenbaum

et al. 2015

J Neuroimmune Pharmacol

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HIV causes neural dysfunction in infected individuals. This dysfunction often manifests as cognitive symptoms and can be detected using neuroimaging. Highly active anti-retroviral therapy (HAART), in addition to providing virologic control, has reduced the number of profoundly impaired individuals but more mild forms of neurocognitive disorders remains prevalent. A potential confound in previous studies of HIV-associated cognitive dysfunction is that HAART may be neurotoxic. Thus, observed effects, attributed to HIV, may be in part due to HAART. It is unclear whether and to what extent current medications contribute to observed brain dysfunction. We studied changes in functional connectivity and cerebral blood flow in HIV uninfected (HIV−) individuals before and after being given two common antiretroviral medications: efavirenz and ritonavir. Neither drug was associated with significant changes in functional connectivity or cerebral blood flow. Our results suggests that previous changes in functional connectivity and cerebral blood flow in HIV infected individuals receiving HAART may largely due to the virus and remaining reservoirs and less due to toxic action of these anti-retroviral medications.

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Neurological disease: the effects of HIV and antiretroviral therapy and the implications for early antiretroviral therapy initiation

Cited by 12 publications

References 54 publications

Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine

Prognosis of fungal infection of central nervous system in HIV-infected patients: a retrospective study of 77 patients in Ukraine

Logistic regression-based parametric analysis of HIV-associated dementia using a screening tool in a tertiary care hospital in Mumbai

Effect of HAART on Brain Organization and Function in HIV-Negative Subjects

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