在最近的联合抗逆转录病毒治疗时代，与 HIV 相关的中枢神经系统疾病。

HIV-associated central nervous system diseases in the recent combination antiretroviral therapy era.

机构信息

Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, London, W2 1NY, UK.

出版信息

Eur J Neurol. 2011 Mar;18(3):527-34. doi: 10.1111/j.1468-1331.2010.03291.x. Epub 2010 Dec 15.

DOI:10.1111/j.1468-1331.2010.03291.x

PMID:21159073

Abstract

BACKGROUND AND PURPOSE

Data describing the incidence and survival of HIV-related central nervous system diseases (CNS-D) in recent years are sparse.

METHODS

Between 1996 and 2007, adult subjects without previous CNS-D within a large UK cohort were included (n=30,954). CNS-D were HIV encephalopathy (HIVe), progressive multifocal leucoencephalopathy (PML), cerebral toxoplasmosis (TOXO) and cryptococcal meningitis (CRYP). Associations between demographic, clinical and laboratory parameters with incidence and survival of CNS-D were evaluated using Poisson regression analysis and Kaplan-Meier techniques.

RESULTS

Six hundred and thirteen new CNS-D occurred in 574 subjects (HIVe:187, PML:113, TOXO:184, CRYP:129). Incidence of all CNS-D declined from 13.1 per 1000 PY in 1996/1997 to 1.0 per 1000 PY in 2006/2007 (P=0.0001). Current CD4+ cell count below 200 cells/ul and plasma HIV RNA above 100,000 copies/ml were independently associated with the development of CNS-D. Calendar year 1996/1997, older age, prior AIDS diagnosis and PML diagnosis were significantly associated with shorter survival.

CONCLUSIONS

An ongoing decline in the incidence of CNS-D has been observed in very recent years. Mortality following such a diagnosis remains high.

摘要

背景与目的

近年来，有关 HIV 相关中枢神经系统疾病（CNS-D）发病率和生存率的数据较为匮乏。

方法

本研究纳入了 1996 年至 2007 年期间英国一个大型队列中无既往 CNS-D 的成年患者（n=30954）。CNS-D 包括 HIV 脑炎（HIVe）、进行性多灶性白质脑病（PML）、脑弓形虫病（TOXO）和隐球菌性脑膜炎（CRYP）。采用泊松回归分析和 Kaplan-Meier 技术评估人口统计学、临床和实验室参数与 CNS-D 发病率和生存率之间的相关性。

结果

574 例患者中发生了 613 例新的 CNS-D（HIVe：187 例，PML：113 例，TOXO：184 例，CRYP：129 例）。所有 CNS-D 的发病率从 1996/1997 年的 13.1/1000 PY 降至 2006/2007 年的 1.0/1000 PY（P=0.0001）。目前 CD4+细胞计数<200 个/μl 和血浆 HIV RNA>100,000 拷贝/ml 与 CNS-D 的发生独立相关。1996/1997 年的日历年度、年龄较大、既往 AIDS 诊断和 PML 诊断与生存率较短显著相关。