Changing incidence of central nervous system diseases in the EuroSIDA cohort.
A drastic decrease in incidence has been observed for most human immunodeficiency virus (HIV)-related opportunistic manifestations after use of highly active antiretroviral therapy (HAART). We assessed the trend of incidence of central nervous system (CNS) diseases in a prospective multicenter observational study involving 9,803 patients across Europe in the period 1994 to 2002 and analyzed patient and treatment variables associated with these conditions. Overall, 568 patients (5.8%) received a diagnosis of a new CNS disease. Incidence decreased significantly from 5.9 per 100 person-year in 1994 to 0.5 in 2002. Overall, the decrease was 40% per calendar year, and it was similar to that of non-CNS diseases and less evident after year 1998. In multivariable models, low CD4 cell count and high plasma viral load, but not HAART or calendar year, were significantly associated with risk to develop CNS disease, indicating that the effect of HAART was likely mediated by both improved immunological conditions and inhibition of viral replication. In contrast, use of nucleoside reverse transcriptase inhibitors, irrespective of use of protease inhibitors or non-nucleoside reverse transcriptase inhibitors, appeared to protect specifically against acquired immunodeficiency disease syndrome dementia complex, suggesting that, in this condition, therapy might have a direct, additive effect in the CNS.
Institute of Infectious and Tropical Diseases, University of Milan, I. Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy. antonella.darminio@unimi.it
Antonella
A
d'Arminio Monforte
Paola
P
Cinque
Amanda
A
Mocroft
Frank-Detlev
FD
Goebel
Francisco
F
Antunes
Christine
C
Katlama
Ulrik Stenz
US
Justesen
Stefano
S
Vella
Ole
O
Kirk
Jens
J
Lundgren
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D000704:Analysis of Variance; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count / Q000379:methods / Q000706:statistics & numerical data; D002493:Central Nervous System Diseases / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D013995:Time; D019562:Viral Load / Q000379:methods / Q000706:statistics & numerical data