title: HIV-associated central nervous system diseases in the recent combination antiretroviral therapy era.
abstract: OBJECTIVE
  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.
authors.affiliation: Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, London, W2 1NY, UK. l.garvey@imperial.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Garvey
authors.forename: Alan
authors.initials: A
authors.lastname: Winston
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.forename: Frank
authors.initials: F
authors.lastname: Post
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Clifford
authors.initials: C
authors.lastname: Leen
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.forename: Teresa
authors.initials: T
authors.lastname: Hill
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Philippa
authors.initials: P
authors.lastname: Easterbrook
authors.forename: Loveleen
authors.initials: L
authors.lastname: Bansi
authors.forename: Chloe
authors.initials: C
authors.lastname: Orkin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ainsworth
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
mesh_terms: D015526:AIDS Dementia Complex / Q000453:epidemiology*; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007968:Leukoencephalopathy, Progressive Multifocal / Q000453:epidemiology / Q000209:etiology; D016919:Meningitis, Cryptococcal / Q000453:epidemiology / Q000209:etiology; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology / Q000209:etiology