Riveiro‐Barciela, 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
Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital
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Medientyp:
E-Artikel
Titel:
Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital
Beteiligte:
Riveiro‐Barciela, 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
Beschreibung:
<jats:sec><jats:title>Background</jats:title><jats:p>Despite the reported decrease in the incidence and mortality rates of central nervous system (<jats:styled-content style="fixed-case">CNS</jats:styled-content>) infections after the introduction of highly active antiretroviral therapy (<jats:styled-content style="fixed-case">HAART</jats:styled-content>), few studies have focused on the global incidence and the relationship of these diseases with immune reconstitution inflammatory syndrome (<jats:styled-content style="fixed-case">IRIS</jats:styled-content>) in the developed world.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A descriptive cohort study of all consecutive adult <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐infected patients with <jats:styled-content style="fixed-case">CNS</jats:styled-content> opportunistic infections diagnosed between 2000 and 2010 in a tertiary hospital in <jats:styled-content style="fixed-case">S</jats:styled-content>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 <jats:styled-content style="fixed-case">J</jats:styled-content>uly 2011, when the study finished. The significance of differences in the incidence rate between early and late <jats:styled-content style="fixed-case">HAART</jats:styled-content> periods was determined using the <jats:styled-content style="fixed-case">M</jats:styled-content>antel–<jats:styled-content style="fixed-case">H</jats:styled-content>aenszel test. Survival distribution was estimated using the <jats:styled-content style="fixed-case">K</jats:styled-content>aplan–<jats:styled-content style="fixed-case">M</jats:styled-content>eier method.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 110 cases of <jats:styled-content style="fixed-case">CNS</jats:styled-content> infections were diagnosed. The incidence of <jats:styled-content style="fixed-case">CNS</jats:styled-content> opportunistic infections decreased from 9 cases per 1000 HIV‐infected patients per year in the early <jats:styled-content style="fixed-case">HAART</jats:styled-content> period to 3.8 in the late <jats:styled-content style="fixed-case">HAART</jats:styled-content> period (<jats:italic><jats:styled-content style="fixed-case">P</jats:styled-content></jats:italic> = 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 <jats:styled-content style="fixed-case">IRIS</jats:styled-content>, 10 (55.6%) were paradoxical and eight (44.4%) were unmasking. <jats:styled-content style="fixed-case">IRIS</jats:styled-content> was not associated with a higher mortality rate.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The annual incidence of <jats:styled-content style="fixed-case">CNS</jats:styled-content> infections decreased progressively during the period of study. The mortality rate associated with these diseases remains high despite <jats:styled-content style="fixed-case">HAART</jats:styled-content>. The development of <jats:styled-content style="fixed-case">IRIS</jats:styled-content> associated with neurological infections had no influence on prognosis.</jats:p></jats:sec>