Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Neurology. 2012 Oct 30;79(18):1873-80. doi: 10.1212/WNL.0b013e318271f7b8. Epub 2012 Oct 17.
To study the incidence and pattern of neurologic disorders in a large cohort of HIV-positive men, compared with HIV-negative men, in the era of highly active antiretroviral therapy (HAART).
The Multicenter AIDS Cohort Study is a prospective study of men who have sex with men enrolled in 4 cities in the United States. We compared HIV-positive vs HIV-negative men for incidence and category of neurologic diagnoses in the HAART era (July 1, 1996, to last known follow-up or death, on or before July 1, 2011).
There were 3,945 participants alive during the HAART era (2,083 HIV negative, 1,776 HIV positive, and 86 who became infected with HIV during the study period) including 3,427 who were older than 40 years of age. Median age at first neurologic diagnosis among all participants alive in the HAART era was lower in HAART-treated HIV-positive vs HIV-negative men (48 vs 57 years of age, p < 0.001). Incidence of neurologic diagnoses was higher in HAART-treated HIV-positive vs HIV-negative men (younger than 40 years: 11.4 vs 0 diagnoses per 1,000 person-years [p < 0.001]; 40-49 years: 11.6 vs 2.0 [p < 0.001]; 50-60 years: 15.1 vs 3.0 [p < 0.001]; older than 60 years: 17.0 vs 5.7 [p < 0.01]). Excess neurologic disease was found in the categories of nervous system infections (p < 0.001), dementia (p < 0.001), seizures/epilepsy (p < 0.01), and peripheral nervous system disorders (p < 0.001), but not stroke (p = 0.60).
HIV-positive men receiving HAART have a higher burden of neurologic disease than HIV-negative men and develop neurologic disease at younger ages.
研究在高效抗逆转录病毒治疗（HAART）时代，大量 HIV 阳性男性与 HIV 阴性男性相比，神经系统疾病的发病率和模式。
多中心艾滋病队列研究是一项对在美国 4 个城市中进行同性性行为的男性进行的前瞻性研究。我们比较了 HIV 阳性与 HIV 阴性男性在 HAART 时代（1996 年 7 月 1 日至最后一次已知随访或死亡，2011 年 7 月 1 日之前）的神经系统诊断的发病率和类别。
HAART 时代有 3945 名存活参与者（2083 名 HIV 阴性，1776 名 HIV 阳性，86 名在研究期间感染 HIV），其中 3427 名年龄大于 40 岁。在 HAART 时代所有存活的参与者中，首次神经系统诊断的中位年龄在接受 HAART 治疗的 HIV 阳性男性中低于 HIV 阴性男性（48 岁 vs 57 岁，p < 0.001）。在接受 HAART 治疗的 HIV 阳性男性中，神经系统诊断的发病率高于 HIV 阴性男性（年龄小于 40 岁：每 1000 人年 11.4 例 vs 0 例[ p < 0.001]；40-49 岁：11.6 例 vs 2.0 例[ p < 0.001]；50-60 岁：15.1 例 vs 3.0 例[ p < 0.001]；年龄大于 60 岁：17.0 例 vs 5.7 例[ p < 0.01]）。神经系统感染（p < 0.001）、痴呆（p < 0.001）、癫痫/癫痫发作（p < 0.01）和周围神经系统疾病（p < 0.001）类别中存在神经疾病的发病率较高，但中风（p = 0.60）除外。
接受 HAART 的 HIV 阳性男性比 HIV 阴性男性有更高的神经疾病负担，并且在更年轻的年龄就出现神经系统疾病。
