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Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital
Author(s) -
RiveiroBarciela M,
Falcó V,
Burgos J,
Curran A,
Van den Eynde E,
Navarro J,
Villar del Saz S,
Ocaña I,
Ribera E,
Crespo M,
Pahissa A
Publication year - 2013
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2012.01033.x
Subject(s) - medicine , immune reconstitution inflammatory syndrome , incidence (geometry) , mortality rate , confidence interval , antiretroviral therapy , cohort , rate ratio , cohort study , pediatrics , human immunodeficiency virus (hiv) , immunology , viral load , physics , optics
Background Despite the reported decrease in the incidence and mortality rates of central nervous system ( CNS ) infections after the introduction of highly active antiretroviral therapy ( HAART ), few studies have focused on the global incidence and the relationship of these diseases with immune reconstitution inflammatory syndrome ( IRIS ) in the developed world. Methods A descriptive cohort study of all consecutive adult HIV ‐infected patients with CNS opportunistic infections diagnosed between 2000 and 2010 in a tertiary hospital in S pain was carried out. Demographic, clinical, laboratory, and microbiological data were recorded. Patients were followed up until death or loss to follow‐up or until 30 J uly 2011, when the study finished. The significance of differences in the incidence rate between early and late HAART periods was determined using the M antel– H aenszel test. Survival distribution was estimated using the K aplan– M eier method. Results A total of 110 cases of CNS infections were diagnosed. The incidence of CNS opportunistic infections decreased from 9 cases per 1000 HIV‐infected patients per year in the early HAART period to 3.8 in the late HAART period ( P = 0.04). Overall, the estimated mean survival time was 58.8 months (95% confidence interval 47.1–70.6 months). Of the 110 patients, 18 (16.4%) met the criteria of IRIS , 10 (55.6%) were paradoxical and eight (44.4%) were unmasking. IRIS was not associated with a higher mortality rate. Conclusions The annual incidence of CNS infections decreased progressively during the period of study. The mortality rate associated with these diseases remains high despite HAART . The development of IRIS associated with neurological infections had no influence on prognosis.