Bacellar H, Muñoz A, Miller E N, Cohen B A, Besley D, Selnes O A, Becker J T, McArthur J C
Johns Hopkins University, Baltimore, MD.
Neurology. 1994 Oct;44(10):1892-900. doi: 10.1212/wnl.44.10.1892.
To describe temporal trends in the incidence of human immunodeficiency virus (HIV)-related neurologic diseases in the Multicenter AIDS Cohort Study from 1985 to 1992.
The incidence rates of six neurologic disorders were examined: toxoplasmosis, cryptococcal meningitis, primary CNS lymphoma, progressive multifocal leukoencephalopathy, HIV dementia, and sensory neuropathy. Poisson modeling was used to test linear trends over time and the effects of progressive immunosuppression, antimicrobial prophylaxis, and antiretroviral drug therapy.
There was an upward temporal trend in all incidence rates, except for HIV dementia. Progressive immunosuppression in the cohort explained all calendar trends except for sensory neuropathy, where an increasing temporal trend remained even after adjusting for CD4+ cell count, and for HIV dementia where a slight decline was noted, although the effects were not statistically significant. We noted a protective trend of antimicrobial prophylaxis on toxoplasmosis and cryptococcal meningitis, but, in contrast, use of antiretroviral agents was not protective against HIV dementia. Men receiving didanosine, zalcitabine, or stavudine were more likely to develop sensory neuropathy.
Despite the earlier and more widespread use of antimicrobial and antiretroviral agents, neurologic conditions still occurred frequently in this cohort, with annual rates above 1.5 per 100 person-years for HIV dementia and sensory neuropathy. Sensory neuropathy seems to be increasing in incidence and HIV dementia declining slightly in this cohort. As the epidemic matures and more people with profound immunosuppression live longer, the overall incidence of HIV-related neurologic diseases can be expected to rise.
描述1985年至1992年多中心艾滋病队列研究中与人类免疫缺陷病毒（HIV）相关的神经系统疾病发病率的时间趋势。
检查了六种神经系统疾病的发病率：弓形虫病、隐球菌性脑膜炎、原发性中枢神经系统淋巴瘤、进行性多灶性白质脑病、HIV痴呆和感觉神经病变。采用泊松模型来检验随时间的线性趋势以及进行性免疫抑制、抗菌预防和抗逆转录病毒药物治疗的效果。
除HIV痴呆外，所有发病率均呈上升的时间趋势。队列中的进行性免疫抑制解释了除感觉神经病变外的所有时间趋势，在感觉神经病变中，即使调整了CD4+细胞计数，时间趋势仍呈上升，而HIV痴呆虽有轻微下降趋势，但差异无统计学意义。我们注意到抗菌预防对弓形虫病和隐球菌性脑膜炎有保护趋势，但相比之下，使用抗逆转录病毒药物对HIV痴呆无保护作用。接受去羟肌苷、扎西他滨或司他夫定的男性更易发生感觉神经病变。
尽管抗菌和抗逆转录病毒药物的使用更早且更广泛，但该队列中神经系统疾病仍频繁发生，HIV痴呆和感觉神经病变的年发病率超过每100人年1.5例。在该队列中，感觉神经病变的发病率似乎在上升，而HIV痴呆略有下降。随着艾滋病流行的成熟以及更多深度免疫抑制患者存活时间延长，预计与HIV相关的神经系统疾病总体发病率将会上升。
