title: Temporal trends in the incidence of HIV-1-related neurologic diseases: Multicenter AIDS Cohort Study, 1985-1992.
abstract: OBJECTIVE
  To describe temporal trends in the incidence of human immunodeficiency virus (HIV)-related neurologic diseases in the Multicenter AIDS Cohort Study from 1985 to 1992.
  
  
  METHODS
  The incidence rates of six neurologic disorders were examined: toxoplasmosis, cryptococcal meningitis, primary CNS lymphoma, progressive multifocal leukoencephalopathy, HIV dementia, and sensory neuropathy. Poisson modeling was used to test linear trends over time and the effects of progressive immunosuppression, antimicrobial prophylaxis, and antiretroviral drug therapy.
  
  
  RESULTS
  There was an upward temporal trend in all incidence rates, except for HIV dementia. Progressive immunosuppression in the cohort explained all calendar trends except for sensory neuropathy, where an increasing temporal trend remained even after adjusting for CD4+ cell count, and for HIV dementia where a slight decline was noted, although the effects were not statistically significant. We noted a protective trend of antimicrobial prophylaxis on toxoplasmosis and cryptococcal meningitis, but, in contrast, use of antiretroviral agents was not protective against HIV dementia. Men receiving didanosine, zalcitabine, or stavudine were more likely to develop sensory neuropathy.
  
  
  CONCLUSIONS
  Despite the earlier and more widespread use of antimicrobial and antiretroviral agents, neurologic conditions still occurred frequently in this cohort, with annual rates above 1.5 per 100 person-years for HIV dementia and sensory neuropathy. Sensory neuropathy seems to be increasing in incidence and HIV dementia declining slightly in this cohort. As the epidemic matures and more people with profound immunosuppression live longer, the overall incidence of HIV-related neurologic diseases can be expected to rise.
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: H
authors.initials: H
authors.lastname: Bacellar
authors.forename: A
authors.initials: A
authors.lastname: Muñoz
authors.forename: E N
authors.initials: EN
authors.lastname: Miller
authors.forename: B A
authors.initials: BA
authors.lastname: Cohen
authors.forename: D
authors.initials: D
authors.lastname: Besley
authors.forename: O A
authors.initials: OA
authors.lastname: Selnes
authors.forename: J T
authors.initials: JT
authors.lastname: Becker
authors.forename: J C
authors.initials: JC
authors.lastname: McArthur
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000628:therapy; D000328:Adult; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D004219:District of Columbia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D010414:Pennsylvania / Q000453:epidemiology; D016012:Poisson Distribution; D012044:Regression Analysis; D013997:Time Factors; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D015215:Zidovudine