Publication: Neurologic disease burden in treated HIV/AIDS predicts survival: A population-based study
Issued Date
2010-09-28
Resource Type
ISSN
1526632X
00283878
00283878
Other identifier(s)
2-s2.0-77957969916
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Neurology. Vol.75, No.13 (2010), 1150-1158
Suggested Citation
P. Vivithanaporn, G. Heo, J. Gamble, H. B. Krentz, A. Hoke, M. J. Gill, C. Power Neurologic disease burden in treated HIV/AIDS predicts survival: A population-based study. Neurology. Vol.75, No.13 (2010), 1150-1158. doi:10.1212/WNL.0b013e3181f4d5bb Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/29531
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
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 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. Copyright © 2010 by AAN Enterprises, Inc.