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，即是否或何时开始对首次癫痫发作的HIV+个体进行长期抗癫痫药物（AED）治疗。在赞比亚，癫痫和艾滋病的发病率都很高，只有酶诱导的抗癫痫药物是常规可用的，抗癫痫药物和抗逆转录病毒药物（ARV）之间的相互作用的风险尤其令人担忧。这项基于赞比亚的前瞻性队列研究对经历过新发癫痫发作的HIV+成人进行了研究，将为HIV/AIDS患者的癫痫复发率和未来癫痫发作的风险因素提供重要见解。从这项工作中获得的知识将有助于临床医生确定何时/是否开始癫痫发作的慢性治疗。该项目还将扩大对赞比亚艾滋病毒/艾滋病患者的神经系统疾病进行流行病学研究的能力，并为今后开展研究奠定基础，以确定同时使用酶诱导抗癫痫药物和抗逆转录病毒药物是否会使患者易发生抗逆转录病毒药物失效，并可能增加艾滋病毒抗药性的风险。 公共卫生相关性：随着抗逆转录病毒疗法在非洲的普及，艾滋病毒正在从致命感染演变为慢性疾病。照顾艾滋病毒/艾滋病患者同时患有其他慢性疾病，如癫痫，是一项挑战，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是最好的。这项对艾滋病毒阳性赞比亚成年人的前瞻性研究将为我们提供重要的见解，了解何时需要长期治疗以预防癫痫发作，并发展研究专业知识和基础知识，以确定在未来的研究中，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代癫痫药物相结合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.