TEMPORAL TRENDS IN THE INCIDENCE OF HTV-1-RELATED NEUROLOGIC DISEASES - MULTICENTER AIDS COHORT STUDY, 1985-1992
TEMPORAL TRENDS IN THE INCIDENCE OF HTV-1-RELATED NEUROLOGIC DISEASES - MULTICENTER AIDS COHORT STUDY, 1985-1992
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DOI：
10.1212/wnl.44.10.1892
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发表时间：
1994-10-01
期刊：
影响因子：
9.9
通讯作者：
MCARTHUR, JC
中科院分区：
文献类型：
--
作者：
BACELLAR, H;MUNOZ, A;MCARTHUR, JC
目的：描述1985年至1992年多中心艾滋病队列研究中人类免疫缺陷病毒（HIV）相关神经系统疾病发病率的时间趋势。研究方法：研究了6种神经系统疾病的发病率：弓形虫病、隐球菌性脑膜炎、原发性CNS淋巴瘤、进行性多灶性白质脑病、HIV痴呆和感觉神经病。Poisson模型用于检验随时间的线性趋势以及进行性免疫抑制、抗菌预防和抗逆转录病毒药物治疗的效果。结果：除HN型痴呆外，其他各型痴呆的发病率均呈上升趋势。队列中的进行性免疫抑制解释了所有日历趋势，但感觉神经病除外，即使在调整CD 4（+）细胞计数后，感觉神经病的时间趋势仍在增加，而HIV痴呆的时间趋势略有下降，尽管影响没有统计学意义。我们注意到抗微生物预防对弓形虫病和隐球菌脑膜炎的保护性趋势，但相反，使用抗逆转录病毒药物对艾滋病毒痴呆没有保护作用。接受去羟肌苷、扎西他滨或司他夫定治疗的男性更容易发生感觉神经病变。结论：尽管早期和更广泛地使用抗微生物和抗逆转录病毒药物，神经系统疾病仍然经常发生在这个队列中，艾滋病毒痴呆和感觉神经病的年发病率超过1.5/100人年。感觉神经病变的发病率似乎在增加，艾滋病毒痴呆在这一队列中略有下降。随着这一流行病的成熟，以及更多的免疫抑制严重的人寿命更长，与艾滋病毒有关的神经系统疾病的总发病率预计会上升。
Objective: To describe temporal trends in the incidence of human immunodeficiency virus (HIV)-related neurologic diseases in the Multicenter AIDS Cohort Study from 1985 to 1992. Methods: The incidence rates of six neurologic disorders were examined: toxoplasmosis, cryptococcal meningitis, primary CNS lymphoma, progressive multifocal leukoencephalopathy, HIV dementia, and sensory neuropathy. Poisson modeling was used to test linear trends over time and the effects of progressive immunosuppression, antimicrobial prophylaxis, and antiretroviral drug therapy. Results: There was an upward temporal trend in all incidence rates, except for HN dementia. Progressive immunosuppression in the cohort explained all calendar trends except for sensory neuropathy, where an increasing temporal trend remained even after adjusting for CD4(+) cell count, and for HIV dementia where a slight decline was noted, although the effects were not statistically significant. We noted a protective trend of antimicrobial prophylaxis on toxoplasmosis and cryptococcal meningitis, but, in contrast, use of antiretroviral agents was not protective against HIV dementia. Men receiving didanosine, zalcitabine, or stavudine were more likely to develop sensory neuropathy. Conclusion: Despite the earlier and more widespread use of antimicrobial and antiretroviral agents, neurologic conditions still occurred frequently in this cohort, with annual rates above 1.5 per 100 person-years for HIV dementia and sensory neuropathy. Sensory neuropathy seems to be increasing in incidence and HIV dementia declining slightly in this cohort. As the epidemic matures and more people with profound immunosuppression live longer, the overall incidence of HIV-related neurologic diseases can be expected to rise.