PMID- 21045634
OWN - NLM
STAT- MEDLINE
DCOM- 20110506
LR  - 20230529
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Print)
IS  - 0269-9370 (Linking)
VI  - 24
IP  - 18
DP  - 2010 Nov 27
TI  - Central nervous system disorders after starting antiretroviral therapy in South 
      Africa.
PG  - 2871-6
LID - 10.1097/QAD.0b013e328340fe76 [doi]
AB  - OBJECTIVE: To describe the spectrum of central nervous system (CNS) disease 
      during the first year of antiretroviral therapy (ART) and to determine the 
      contribution of neurological immune reconstitution inflammatory syndrome (IRIS). 
      DESIGN: A prospective observational cohort study conducted over a 12-month period 
      at a public sector referral hospital in South Africa. METHODS: HIV-seropositive 
      patients who developed new or recurrent neurological or psychiatric symptom(s) or 
      sign(s) within the first year of starting ART were enrolled. We used the number 
      of patients starting ART in the referral area in the preceding year as the 
      denominator to calculate the incidence of referral for neurological 
      deterioration. Patients with delirium and peripheral neuropathy were excluded. 
      Outcome at 6 months was recorded. RESULTS: Seventy-five patients were enrolled. 
      The median nadir CD4(+) cell counts was 64 cells/mul. Fifty-nine percent of the 
      patients were receiving antituberculosis treatment. The incidence of referral for 
      CNS deterioration in the first year of ART was 23.3 cases [95% confidence 
      interval (CI), 18.3-29.2] per 1000 patient-years at risk. CNS tuberculosis (n = 
      27, 36%), cryptococcal meningitis (n = 18, 24%), intracerebral space occupying 
      lesions (other than tuberculoma) (n = 10, 13%) and psychosis (n = 9, 12%) were 
      the most frequent diagnoses. Paradoxical neurological IRIS was diagnosed in 21 
      patients (28%), related to tuberculosis in 16 and cryptococcosis in five. At 6 
      months, 23% of the patients had died and 20% were lost to follow-up. CONCLUSION: 
      Opportunistic infections, notably tuberculosis and cryptococcosis, were the most 
      frequent causes for neurological deterioration after starting ART. Neurological 
      IRIS occurred in over a quarter of patients.
FAU - Asselman, Valerie
AU  - Asselman V
AD  - Department of Medicine, GF Jooste Hospital, Cape Town, South Africa.
FAU - Thienemann, Friedrich
AU  - Thienemann F
FAU - Pepper, Dominique J
AU  - Pepper DJ
FAU - Boulle, Andrew
AU  - Boulle A
FAU - Wilkinson, Robert J
AU  - Wilkinson RJ
FAU - Meintjes, Graeme
AU  - Meintjes G
FAU - Marais, Suzaan
AU  - Marais S
LA  - eng
GR  - U2R TW007370/TW/FIC NIH HHS/United States
GR  - 081667/WT_/Wellcome Trust/United Kingdom
GR  - 088316/WT_/Wellcome Trust/United Kingdom
GR  - U2R TW007373/TW/FIC NIH HHS/United States
GR  - MC_U117588499/MRC_/Medical Research Council/United Kingdom
GR  - U117588499(88499)/MRC_/Medical Research Council/United Kingdom
GR  - U2R TW007370-01A1/TW/FIC NIH HHS/United States
GR  - U2R TW007373-01A1/TW/FIC NIH HHS/United States
GR  - 084323/WT_/Wellcome Trust/United Kingdom
GR  - 072070/WT_/Wellcome Trust/United Kingdom
GR  - WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Alkynes)
RN  - 0 (Benzoxazines)
RN  - 0 (Cyclopropanes)
RN  - JE6H2O27P8 (efavirenz)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*chemically 
      induced/epidemiology/physiopathology
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Alkynes
MH  - Antiretroviral Therapy, Highly Active
MH  - Benzoxazines/*adverse effects
MH  - CD4 Lymphocyte Count
MH  - Cyclopropanes
MH  - Female
MH  - HIV Seropositivity/*drug therapy/epidemiology/physiopathology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*chemically 
      induced/epidemiology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - South Africa/epidemiology
MH  - Young Adult
PMC - PMC3077551
MID - NIHMS252693
COIS- Conflicts of interest We declare no conflict of interest.
EDAT- 2010/11/04 06:00
MHDA- 2011/05/07 06:00
PMCR- 2011/05/27
CRDT- 2010/11/04 06:00
PHST- 2010/11/04 06:00 [entrez]
PHST- 2010/11/04 06:00 [pubmed]
PHST- 2011/05/07 06:00 [medline]
PHST- 2011/05/27 00:00 [pmc-release]
AID - 10.1097/QAD.0b013e328340fe76 [doi]
PST - ppublish
SO  - AIDS. 2010 Nov 27;24(18):2871-6. doi: 10.1097/QAD.0b013e328340fe76.