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The incidence of many neurologic complications of HIV infection has fallen dramatically since effective combination antiretroviral therapy (ART) was introduced in 1996. To determine whether HIV infection continues to have an effect on neurologic disorders during the era of combination ART, investigators studied a large cohort of men followed between July 1996 and June 2011 in the Multicenter AIDS Cohort Study.
HIV-positive (n=1862) and HIV-negative (n=2169) men who have sex with men were included in the analyses. In the HIV-positive men, the median CD4 count was 585 cells/mm3, and the average duration of ART use was 10.6 years. The incidence of neurologic disorders was higher in HIV-positive men than in HIV-negative men. The median age of first neurologic diagnosis was 48 in the HIV-positive men compared with 57 in the HIV-negative ones. Peripheral nerve and muscle disorders (the most common diagnoses), nervous system infections, dementia, and seizures were more common in HIV-infected than in HIV-negative men; when only confirmed cases were counted, stroke was not more common in the HIV-infected group. Although this study took place during the era of effective therapy, 21% of HIV-infected patients with a neurologic disorder were not receiving ART at the time of the complication.
Mateen FJ et al. Neurologic disorders incidence in HIV+ vs HIV– men: Multicenter AIDS Cohort Study, 1996–2011. Neurology 2012 Oct 30; 79:1873.
Comment
This study suggests that HIV infection may increase the rate — and perhaps accelerate the development — of neurologic disorders. However, the relevance of these findings to patients who are doing well on current therapy is difficult to know. A substantial fraction of patients who developed neurologic complications were not receiving ART, and, of those on treatment, we are not told what proportion had virologic suppression. Moreover, the development of some diagnoses in this study, such as peripheral neuropathy, may have been exacerbated by antiretrovirals that we no longer use (e.g., stavudine, didanosine). Also, because ascertainment of neurologic conditions in this study was based on medical record review, more recently recognized and subtle entities, such as mild neurocognitive disorder, were not included. Nevertheless, this study highlights the importance of following HIV-infected patients closely for neurologic disorders and emphasizes the need to initiate effective ART before such complications develop.