Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital. Issue 1 (25th June 2012)

• Record Type: Journal Article
• Authors: Riveiro‐Barciela, M; Falcó, V; Burgos, J; Curran, A; Van den Eynde, E; Navarro, J; Villar del Saz, S; Ocaña, I; Ribera, E; Crespo, M; Pahissa, A
• Is Part Of: HIV medicine. Volume 14:Issue 1(2013:Jan.)
• Page Start: 21
• Page End: 30
• Publication Date: 2012-06-25
• Subjects: HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/j.1468-1293.2012.01033.x
• Languages: English
• ISSNs: 1464-2662

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hiv1033-sec-0001" sec-type="section"> <title>Background</title> <p>Despite the reported decrease in the incidence and mortality rates of central nervous system (CNS) infections after the introduction of highly active antiretroviral therapy (HAART), few studies have focused on the global incidence and the relationship of these diseases with immune reconstitution inflammatory syndrome (IRIS) in the developed world.</p> </sec> <sec id="hiv1033-sec-0002" sec-type="section"> <title>Methods</title> <p>A descriptive cohort study of all consecutive adult HIV‐infected patients with CNS opportunistic infections diagnosed between 2000 and 2010 in a tertiary hospital in Spain was carried out. Demographic, clinical, laboratory, and microbiological data were recorded. Patients were followed up until death or loss to follow‐up or until 30 July 2011, when the study finished. The significance of differences in the incidence rate between early and late HAART periods was determined using the Mantel–Haenszel test. Survival distribution was estimated using the Kaplan–Meier method.</p> </sec> <sec id="hiv1033-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 110 cases of CNS infections were diagnosed. The incidence of CNS opportunistic infections decreased from 9 cases per 1000 HIV‐infected patients per year in the early HAART period to 3.8 in the late HAART period (<italic>P</italic> = 0.04). Overall, the estimated mean survival time was 58.8 months (95% confidence interval 47.1–70.6 months). Of the 110 patients, 18 (16.4%) met the criteria of IRIS, 10 (55.6%) were paradoxical and eight (44.4%) were unmasking. IRIS was not associated with a higher mortality rate.</p> </sec> <sec id="hiv1033-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The annual incidence of CNS infections decreased progressively during the period of study. The mortality rate associated with these diseases remains high despite HAART. The development of IRIS associated with neurological infections had no influence on prognosis.</p> </sec> </abstract>