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NEUROLOGY 1994;44:1892
© 1994 American Academy of Neurology

Temporal trends in the incidence of HTV-1-related neurologic diseases

Multicenter AIDS Cohort Study, 1985-1992

H. Bacellar, MA, A. Muñoz, PhD, E. N. Miller, PhD, B. A. Cohen, MD, D. Besley, MD, O. A. Seines, PhD, J. T. Becker, PhD and J. C. McArthur, MBBS, MPH

See Note at end of article for composition of the Multicenter AIDS Cohort Study.

Objective: To describe temporal trends in the incidence of human immunodeficiency virus (HIV)-re-lated neurologic diseases in the Multicenter AIDS Cohort Study from 1985 to 1992.

Methods: 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.

Results: 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.

Conclusion: 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.

Address correspondence and reprint requests to Dr. Justin McArthur, Johns Hopkins Hospital, Meyer 6-109, 600 N. Wolfe Street, Baltimore, MD 21287-7609.

From Johns Hopkins University (H. Bacellar and Drs. Muñoz, Seines, and McArthur), Baltimore, MD; University of California at Los Angeles (Drs. Miller and Besley), Los Angeles, CA; Northwestern University School of Medicine (Dr. Cohen), Chicago, IL; and University of Pittsburgh (Dr. Becker), Pittsburgh, PA.

Supported by UO1-AI-35042, UO1-AI-35043, UO1-AI-35039, UO1-AI-35040, UO1-AI-35041, and RR-00722.

Received February 8, 1994. Accepted in final form April 19, 1994.




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