d'Arminio Monforte Antonella, Cinque Paola, Mocroft Amanda, Goebel Frank-Detlev, Antunes Francisco, Katlama Christine, Justesen Ulrik Stenz, Vella Stefano, Kirk Ole, Lundgren Jens
Institute of Infectious and Tropical Diseases, University of Milan, I. Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy.
Ann Neurol. 2004 Mar;55(3):320-8. doi: 10.1002/ana.10827.
A drastic decrease in incidence has been observed for most human immunodeficiency virus (HIV)-related opportunistic manifestations after use of highly active antiretroviral therapy (HAART). We assessed the trend of incidence of central nervous system (CNS) diseases in a prospective multicenter observational study involving 9,803 patients across Europe in the period 1994 to 2002 and analyzed patient and treatment variables associated with these conditions. Overall, 568 patients (5.8%) received a diagnosis of a new CNS disease. Incidence decreased significantly from 5.9 per 100 person-year in 1994 to 0.5 in 2002. Overall, the decrease was 40% per calendar year, and it was similar to that of non-CNS diseases and less evident after year 1998. In multivariable models, low CD4 cell count and high plasma viral load, but not HAART or calendar year, were significantly associated with risk to develop CNS disease, indicating that the effect of HAART was likely mediated by both improved immunological conditions and inhibition of viral replication. In contrast, use of nucleoside reverse transcriptase inhibitors, irrespective of use of protease inhibitors or non-nucleoside reverse transcriptase inhibitors, appeared to protect specifically against acquired immunodeficiency disease syndrome dementia complex, suggesting that, in this condition, therapy might have a direct, additive effect in the CNS.
在使用高效抗逆转录病毒疗法（HAART）后，大多数与人类免疫缺陷病毒（HIV）相关的机会性表现的发病率已大幅下降。我们在一项前瞻性多中心观察性研究中评估了1994年至2002年期间欧洲9803名患者中枢神经系统（CNS）疾病的发病率趋势，并分析了与这些疾病相关的患者和治疗变量。总体而言，568名患者（5.8%）被诊断患有新的中枢神经系统疾病。发病率从1994年的每100人年5.9例显著下降至2002年的0.5例。总体而言，每年下降40%，与非中枢神经系统疾病的下降情况相似，且在1998年后不太明显。在多变量模型中，低CD4细胞计数和高血浆病毒载量与发生中枢神经系统疾病的风险显著相关，但HAART或日历年与该风险无关，这表明HAART的效果可能是通过改善免疫状况和抑制病毒复制来介导的。相比之下，无论是否使用蛋白酶抑制剂或非核苷类逆转录酶抑制剂，使用核苷类逆转录酶抑制剂似乎都能特别预防获得性免疫缺陷综合征痴呆综合征，这表明在这种情况下，治疗可能在中枢神经系统中具有直接的累加效应。
