HIV-related neuropathology, 1985 to 1999: rising prevalence of HIV encephalopathy in the era of highly active antiretroviral therapy.
Postmortem neuropathologic reports for a consecutive series of 436 HIV-seropositive patients who died between 1985 and 1999 were matched with clinical data for 371 of them. Cases were divided into four groups depending on the date of death. The chosen time periods reflected the type of antiretroviral therapy available: before 1987 (before zidovudine); 1987-1992, the period of monotherapy (nucleoside analog reverse transcriptase inhibitors [NRTIs]); 1993-1995, the era of the use of dual NRTI combinations; and 1996-1999, the era of highly active antiretroviral therapy (HAART) containing protease inhibitors. Fifty-seven percent of our cases in this group had been prescribed HAART. In our study population, accessibility to the latest antiretroviral therapy was widespread. The total number of HIV autopsies declined after the advent of combination therapy. The prevalence of opportunistic infections-cytomegalovirus, toxoplasmosis, cryptococcosis, and central nervous system lymphoma-decreased over time. Cerebral tuberculosis, aspergillosis, herpes, and progressive multifocal leukoencephalopathy showed a downward trend, but the numbers were too low for statistical analyses. The incidence of HIV encephalopathy increased over time (p =.014). The rising prevalence of HIV encephalopathy at time of death may reflect a longer survival time after initial HIV infection in the HAART era. Although combination therapies decrease overall mortality and prevalence of CNS opportunistic infections, these therapies may be less active in preventing direct HIV-1 effects on the brain.
Neuenburg
Jutta K
JK
Department of Neurology, University of California, San Francisco, USA. jneuenburg@gladstone.ucsf.edu
Brodt
Hans R
HR
Herndier
Brian G
BG
Bickel
Markus
M
Bacchetti
Peter
P
Price
Richard W
RW
Grant
Robert M
RM
Schlote
Wolfgang
W
D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000453:epidemiology*; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001344:Autopsy; D001932:Brain Neoplasms / Q000453:epidemiology; D015331:Cohort Studies; D003453:Cryptococcosis / Q000453:epidemiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008223:Lymphoma / Q000453:epidemiology; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014123:Toxoplasmosis / Q000453:epidemiology
D019380:Anti-HIV Agents