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Eur J Neurol. 2011 Mar;18(3):527-34. doi: 10.1111/j.1468-1331.2010.03291.x. Epub 2010 Dec 15.

HIV-associated central nervous system diseases in the recent combination antiretroviral therapy era.

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1
Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, London, W2 1NY, UK. l.garvey@imperial.ac.uk

Abstract

BACKGROUND AND PURPOSE:

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.

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