We investigated trends in neurological complications of
infection with human immunodeficiency virus (HIV) in Japan after the introduction of
highly active antiretroviral therapy (
HAART). Two questionnaire surveys were performed in hospitals treating
acquired immunodeficiency syndrome (
AIDS) to compare two periods: immediately after the introduction of
HAART (1999-2001); and a few years later (2002-3). Neurological complications accompanied 15.9% in 1999-2001 and 9.8% in 2002-3. Neurological complications developed without
HAART in about 80% of cases. Neurological complications developed as the
first AIDS-defining disease for 8.3% of
AIDS patients in 1999-2001 and for 5.4% in 2002-3. Prevalences of
HIV encephalopathy and
myelopathy decreased markedly over the study period, as reported in other developed nations. However, prevalences of cytomegalovirus
encephalitis, PML and primary brain
lymphoma did not decrease. PML and primary brain
lymphoma occurred in patients who received
HAART and whose CD4 counts were relatively high during the study period. This is probably related to the extended survival of HIV-infected individuals after the introduction of
HAART as a worldwide
therapy, and the reactivation of
viremia or
latent infection persisting within the central nervous system.