HIV-associated central nervous system diseases in the recent combination antiretroviral therapy era

Lucy Garvey, Alan Winston, John Walsh, Frank Post, Kholoud Porter, Brian Gazzard, Martin Fisher, Clifford Leen, Deenan Pillay, Teresa Hill, Margaret Johnson, Richard Gilson, Jane Anderson, Philippa Easterbrook, Loveleen Bansi, Chloe Orkin, Jonathan Ainsworth, Andrew N Phillips, Caroline A Sabin
European Journal of Neurology 2011, 18 (3): 527-34

BACKGROUND AND PURPOSE: Data describing the incidence and survival of HIV-related central nervous system diseases (CNS-D) in recent years are sparse.

METHODS: Between 1996 and 2007, adult subjects without previous CNS-D within a large UK cohort were included (n=30,954). CNS-D were HIV encephalopathy (HIVe), progressive multifocal leucoencephalopathy (PML), cerebral toxoplasmosis (TOXO) and cryptococcal meningitis (CRYP). Associations between demographic, clinical and laboratory parameters with incidence and survival of CNS-D were evaluated using Poisson regression analysis and Kaplan-Meier techniques.

RESULTS: Six hundred and thirteen new CNS-D occurred in 574 subjects (HIVe:187, PML:113, TOXO:184, CRYP:129). Incidence of all CNS-D declined from 13.1 per 1000 PY in 1996/1997 to 1.0 per 1000 PY in 2006/2007 (P=0.0001). Current CD4+ cell count below 200 cells/ul and plasma HIV RNA above 100,000 copies/ml were independently associated with the development of CNS-D. Calendar year 1996/1997, older age, prior AIDS diagnosis and PML diagnosis were significantly associated with shorter survival.

CONCLUSIONS: An ongoing decline in the incidence of CNS-D has been observed in very recent years. Mortality following such a diagnosis remains high.

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