Changing incidence of central nervous system diseases in the EuroSIDA cohort

Monforte, Antonella d’Arminio; Cinque, Paola; Mocroft, Amanda; Goebel, F. D.; Antúnes, Francisco; Katlama, Christine; Justesen, Ulrik Stenz; Vella, Stefano; Kirk, Ole; Lundgren, Jens D.

doi:10.1002/ana.10827

Cited by 239 publications

(78 citation statements)

References 32 publications

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“…It has been shown to decrease the plasma viral load level to non-detectable in the majority of compliant patients 2. Consequently, HAART has altered the epidemiology of CNS disease in HIV patients 3 4. Specifically, the incidence of opportunistic CNS infections, such as toxoplasmosis and progressive multifocal leukoencephalopathy (PML), has significantly declined 5…”

Section: Introductionmentioning

confidence: 99%

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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Early brain biopsy may be indicated in HIV patients with focal brain lesion. This study aimed to evaluate and compare the safety and diagnostic value of brain biopsy in HIV patients in the pre-highly active antiretroviral therapy (HAART) versus post-HAART era via meta-analysis. Appropriate studies were identified per search criteria. The local database was retrospectively reviewed to select a similar patient cohort. Patient demographics, brain biopsy technique, histopathology and patient outcomes were extracted from each study. Study-specific outcomes were combined per random-effects model. Outcomes were compared between the pre-HAART and post-HAART era. Correlations between outcomes and baseline characteristics were assessed via meta-regression analysis. The proportions of histopathological diagnosis were tabulated and compared between the pre- and post-HAART era. Survival analysis was performed for patients in the post-HAART era. A total of 26 studies (including the local database) with 1209 patients were included in this meta-analysis. The most common indications for brain biopsy were diagnosis unlikely to be toxoplasmosis (n=8, 42.1%), focal brain lesion (n=5, 26.3%) or both (n=3, 15.8%). The weighted proportions for diagnostic success were 92% (95% CI 90.0% to 93.8%), change in management 57.7% (45.9% to 69.1%) and clinical improvement 36.6% (26.3% to 47.5%). Morbidity and mortality were 5.7% (3.6% to 8.3%) and 0.9% (0.3% to 1.9%), respectively. Diagnostic success rate was significantly higher in the post-HAART than the pre-HAART era (97.5% vs 91.9%, p=0.047). The odds ratio (OR) for diagnostic success in patients with contrast-enhanced lesions was 2.54 ((1.25 to 5.15), p<0.01). The median survival for HIV patients who underwent biopsy in the post-HAART era was 225 days (90-2446). Brain biopsy in HIV patients is safe with high diagnostic yield. Early brain biopsy should be considered in patients without classic presentation of toxoplasmosis encephalitis.

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Section: Introductionmentioning

confidence: 99%

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Since the introduction of HAART, morbidity and mortality secondary to primary and secondary neurological opportunistic diseases in HIV-1/AIDS patients have significantly decreased [2,3]. However, neurocognitive impairments continue to occur in high frequencies, even in countries, with a free and universal access program to HAART, such as Brazil [4].…”

Section: Introductionmentioning

confidence: 99%

BK virus associated meningoencephalitis in an AIDS patient treated with HAART

et al. 2007

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A severely immune-suppressed AIDS patient was suspected of suffering from BK virus (BKV) meningoencephalitis, after being studied for common causes of neurological complications of co-infectious origin. Polymerase chain reaction (PCR) and sequence analysis of cerebrospinal fluid and brain samples, confirmed the presence of BKV. His clinical condition improved along with the regression of brain lesions, after modifications on his antiretroviral regime. Five months after discharge, the patient was readmitted because of frequent headaches, and a marked inflammatory reaction was evidenced by a new magnetic resonance imaging (MRI). The symptoms paralleled a rising CD4+ lymphocyte count, and immune reconstitution syndrome was suspected. This is the first non-postmortem report of BKV meningoencephalitis in an AIDS patient, showing clinical and radiographic improvement solely under HAART.

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“…Widespread use of ART has reduced nearly all of the complications of advanced HIV infection and immunosuppression in regions where therapy is available, including CNS opportunistic infections and the AIDS dementia complex (ADC) [2]. …”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid signs of neuronal damage after antiretroviral treatment interruption in HIV-1 infection

et al. 2005

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BackgroundThe neurofilament is a major structural component of myelinated axons. Increased cerebrospinal fluid (CSF) concentrations of the light chain of the neurofilament protein (NFL) can serve as a sensitive indicator of central nervous system (CNS) injury. To assess whether interrupting antiretroviral treatment of HIV infection might have a deleterious effect on the CNS, we measured NFL levels in HIV-infected subjects interrupting therapy.We identified subjects who had CSF HIV RNA concentrations below 50 copies/mL at the time combination antiretroviral therapy was interrupted, and for whom CSF samples were available before and after the interruption.ResultsA total of 8 subjects were studied. The median (range) CSF NFL level at baseline was <125 (<125–220) ng/L (normal <250 ng/L). All 8 subjects exhibited an increase in CSF and plasma HIV RNA after stopping therapy, accompanied by intrathecal immunoactivation as evidenced by CSF lymphocytic pleocytosis (7/8 patients) and increased CSF neopterin concentration (5/6 patients). Three subjects showed a consistent increase in CSF NFL, rising from <125 ng/L to a maximum of 880 (at day 148), 1,010 (day 58) and 10,930 ng/L (day 101). None exhibited new neurological symptoms or signs, or experienced functional deterioration during the period off treatment; of 5 who underwent brief quantitative neurological testing, none showed worsening performance.ConclusionThese findings suggest that resurgence of active HIV replication may result in measurable, albeit subclinical, CNS injury. Further studies are needed to define the frequency and pathobiological importance of the increase in CSF NFL.

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Changing incidence of central nervous system diseases in the EuroSIDA cohort

Cited by 239 publications

References 32 publications

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

BK virus associated meningoencephalitis in an AIDS patient treated with HAART

Cerebrospinal fluid signs of neuronal damage after antiretroviral treatment interruption in HIV-1 infection

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