Neurological disease in HIV-infected patients in the era of highly active antiretroviral treatment: a Brazilian experience

Abstract

To study characteristics of neurological disorders in HIV/AIDS patients and their relationship to highly active antiretroviral treatment, a cross-sectional study was conducted in an infectious disease public hospital in Belo Horizonte, Brazil, between February 1999 and March 2000. Of the 417 patients enrolled, neurological disease was observed in 194 (46.5%) and a new AIDS-defining neurological event developed in 23.7% of individuals. Toxoplasmosis (42.3%), cryptococcosis meningitis (12.9%) and tuberculosis (10.8%) were the most common causes of neurological complications. The majority (79.3%) of patients were on highly active antiretroviral treatment and these individuals using HAART showed higher CD4 cell counts (p = 0.014) and presented stable neurological disease (p= 0.0001), although no difference was found with respect to the profile of neurological complications. The neurological diseases continue to be a frequent complication of HIV/AIDS and infections are still its main causes in Brazil, even in the highly active antiretroviral treatment era. Key-words: HIV infection. AIDS. Neurological disease. Highly active antiretroviral treatment. Brazil. RESUMOCom o objetivo de estudar as doenças neurológicas em pacientes HIV/AIDS e sua relação com a terapia anti-retroviral altamente ativa, foi realizado estudo transversal em hospital público de doenças infecciosas de Belo Horizonte, Brasil, no período de fevereiro de 1999 a março de 2000. Doença neurológica foi observada em 194 (46,5%) dos 417 indivíduos incluídos e um novo episódio de doença neurológica definidora de AIDS ocorreu em 23,7% pacientes. Toxoplasmose (42,3%), criptococose (12,9%) e tuberculose (10,8%) foram as principais causas de complicações neurológicas. A maioria dos pacientes estava em uso de terapia anti-retroviral altamente ativa (79,3%) e esses indivíduos apresentaram maiores contagens de linfócitos CD4 (p = 0,014) e maior freqüência de doença neurológica clinicamente estável, embora não tenha havido diferença no perfil etiológico das complicações neurológicas. As doenças neurológicas continuam sendo causas freqüentes de complicações da infecção pelo HIV/AIDS no Brasil, e a despeito da terapia anti-retroviral altamente ativa, as infecções são ainda a principal etiologia das doenças do sistema nervoso. Palavras-chaves: Infecção pelo HIV. SIDA. Doença neurológica. Terapia anti-retroviral altamente ativa. Brasil.

Seroprevalence of Toxoplasma gondii IgG antibody in HIV/AIDS-infected individuals in Maputo, Mozambique

“…2,3,9,20,22,23 The prevalence of latent infection by T. gondii found in this study was higher than most estimates in other studies conducted with HIV/AIDS positive individuals in many places around the world, particularly in neighboring countries belonging to sub-Saharan Africa. The estimates vary from 4.0% to 8.0% in Zambia, 5.0% to 17.0% in South Africa, 19.0% in Zimbabwe, 26.0% in Angola, 36.5% in Nigeria, 44.0% in Namibia, Uganda on 34.0% to 54.0%, 40.0% to 70.0% in Tanzania, 55.5% Kenya and 93.0% in Ethiopia.…”

“…4 Even in the era after the introduction of HAART, it still represents important public health problem, especially to vulnerable populations in developing and developed countries. 2 This study has important implications, considering the possibility of reducing morbidity and mortality and increased survival in patients infected with HIV/AIDS with the adoption and development of HAART, both in adults and in children. 2,17 Different studies indicate changing clinical and epidemiological patterns related to neurotoxoplamosis 2,7,17 and its association with immune reconstitution inflammatory syndrome (IRIS).…”

“…2,17 Different studies indicate changing clinical and epidemiological patterns related to neurotoxoplamosis 2,7,17 and its association with immune reconstitution inflammatory syndrome (IRIS). 2,15 Together, these findings extend the importance of adopting screening routines for T. gondii infection in all newly diagnosed cases of HIV infection, with follow-up serologic depending on the context of risk associated with each individual.…”

“…16 The high burden of opportunistic infections with T. gondii, especially in immunocompromised individuals, mainly verified from 1980s, remains a significant public health problem in some countries, especially those that have failed to gain universal access to highly active antiretroviral therapy (HAART). 2,4 RESUMO OBJETIVO: Avaliar a prevalência de anticorpos IgG anti-Toxoplasma gondii em pessoas infectadas pelo HIV/Aids e a associação de variáveis demográficas e sociais.…”

Soap bubble appearance in brain magnetic resonance imaging: cryptococcal meningoencephalitis

“…Cryptococcosis is the most frequent opportunistic fungal infection that involves the CNS in patients with acquired immunodeficiency syndrome (AIDS) or in other immunocompromised patients 5,6 . The absence of clinical signs of meningeal irritation and CSF pleocytosis refl ects the paucity of infl ammation due to the severe condition of immunosuppression in these patients 1,3 .…”