A Cohort Study of Seizures and Epilepsy in HIV+ Zambian Adults

描述(由申请人提供)：癫痫发作是HIV感染者中最常见的神经系统事件之一，但几乎没有流行病学数据可用于指导临床决策，即是否或何时对首次发作的HIV+患者启动长期抗癫痫药物(AED)治疗。在赞比亚，癫痫和艾滋病的流行率都很高，而且通常只有酶诱导的AEDs，AEDs与抗逆转录病毒药物(ARV)相互作用的风险尤其令人担忧。这项以赞比亚为基地的前瞻性队列研究对经历了新的癫痫发作的艾滋病毒+成年人进行了研究，将为了解艾滋病毒/艾滋病患者的癫痫复发率和未来癫痫发作的风险因素提供重要的见解。从这项工作中获得的知识将有助于临床医生确定何时/是否开始对癫痫发作进行慢性治疗。该项目还将扩大赞比亚艾滋病毒/艾滋病患者中神经疾病的流行病学研究能力，并为今后开展研究奠定基础，这些研究旨在确定联合使用酶诱导AEDs和抗逆转录病毒药物是否会使患者易受抗逆转录病毒药物失败的影响，并可能增加抗药性艾滋病毒的风险。 与公共卫生相关：随着抗逆转录病毒治疗在非洲得到广泛应用，艾滋病毒正在从一种致命感染演变为一种慢性病。照顾患有其他慢性疾病(如癫痫)的艾滋病毒/艾滋病患者是具有挑战性的，因为临床医生没有足够的知识来知道当这些疾病同时发生时，什么治疗方法是最好的。这项对艾滋病毒携带者和赞比亚成年人的前瞻性研究将为我们提供重要的见解，使我们了解何时需要进行预防癫痫的慢性治疗，并发展研究专业知识和基础知识，以便在未来的研究中确定，将抗逆转录病毒药物与仍在大多数资源匮乏环境中使用的老一辈癫痫药物结合使用是否会增加抗逆转录病毒药物失败的风险。

DESCRIPTION (provided by applicant): Seizures are among the most common neurologic events that occur among people with HIV, but there is little epidemiologic data available to guide clinical decision-making regarding whether or when to initiate long term antiepileptic drug (AED) treatment for HIV+ individuals who experience a first seizure. In Zambia, where epilepsy and AIDS prevalence rates are both high and only enzyme-inducing AEDs are routinely available, the risk of interactions between AEDs and antiretroviral medications (ARVs) is especially concerning. This Zambian-based prospective cohort study of HIV+ adults who have experienced new onset seizure will provide important insights into seizure recurrence rates and risk factors for future seizures in people with HIV/AIDS. Knowledge gained from this work will assist clinicians in determining when/whether to initiate chronic treatment for seizures. This project will also expand the capacity for epidemiologic studies of neurologic disorders among people with HIV/AIDS in Zambia and lay the groundwork for the conduct of future research aimed at determining whether the co-usage of enzyme-inducing AEDs and ARVs predispose patients to ARV drug failure and potentially increase the risk of drug resistant HIV. PUBLIC HEALTH RELEVANCE: As antiretroviral treatments become broadly available in Africa, HIV is evolving from a fatal infection into a chronic condition. Caring for people with HIV/AIDS who also suffer from other chronic health conditions, such as epilepsy, is challenging because clinicians do not have sufficient knowledge to know what treatments are best when these disorders co-occur. This prospective study of HIV+ Zambian adults will provide us with important insights into when chronic treatment for seizure prevention is needed and develop the research expertise and foundational knowledge to determine, in future studies, whether combining antiretroviral medications with the older generation epilepsy medications still used in most resource poor settings increases the risk of antiretroviral drug failure.