Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.

Abstract

BACKGROUND:

Combination antiretroviral therapy (cART) has improved the survival of patients with HIV/AIDS but its impact remains uncertain on the changing prevalence and incidence of neurologic disorders with ensuing effects on mortality.

METHODS:

The prevalence and incidence of neurologic disorders were examined in patients receiving active care in a regional HIV care program from 1998 to 2008. The mortality hazard ratio (HR) was calculated by Cox proportional hazard models with adjustment for demographic and clinical variables.

RESULTS:

Of 1,651 HIV-infected patients assessed, 404 (24.5%) were identified as having one or more neurologic disorders, while 41% of AIDS-affected persons exhibited neurologic disease. Symptomatic distal sensory polyneuropathy (DSP, 10.0%) and HIV-associated neurocognitive disorder (HAND, 6.2%) represented the most prevalent disorders among 53 recognized neurologic disorders. Patients with at least one neurologic disorder exhibited higher mortality rates (17.6% vs 8.0%, p < 0.0001), particularly AIDS-related deaths (9.7% vs 3.2%, p < 0.0001), compared with those without neurologic disorders. The highest mortality HR was associated with opportunistic infections of CNS (HR 5.3, 95% confidence interval [CI] 2.5-11.2), followed by HAND (HR 3.1, 95% CI 1.8-5.3) and the presence of any neurologic disorder (HR 2.0, 95% CI 1.2-3.2). The risk of AIDS-related death with a neurologic disorder was increased by 13.3% per 100 cells/mm(3) decrement in blood CD4+ T-cell levels or by 39% per 10-fold increment in plasma viral load.

CONCLUSIONS:

The burden and type of HIV-related neurologic disease have evolved over the past decade and despite the availability of cART, neurologic disorders occur frequently and predict an increased risk of death.

• Authors: P Vivithanaporn, G Heo, J Gamble, H B Krentz, A Hoke, M J Gill, C Power
• Journal: Neurology (Neurology) Vol. 75 Issue 13 Pg. 1150-8 (Sep 28 2010) ISSN: 1526-632X [Electronic] United States
• PMID: 20739646 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Community Health Planning
• Female
• HIV Infections (complications, diagnosis, epidemiology, mortality)
• Humans
• Incidence
• Male
• Nervous System Diseases (diagnosis, epidemiology, etiology)
• Predictive Value of Tests
• Prevalence
• Proportional Hazards Models
• Retrospective Studies