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Despite the availability of antiretroviral (ARV) therapy, neurologic disorders occur frequently in HIV/AIDS patients and increase the risk of death, a study in Canada finds. This may reflect late diagnosis and entry into care, so efforts to identify people with HIV earlier are vital, AIDS expert Dr. Julio Montaner said. Researchers examined 1,651 HIV-positive patients receiving care at the Southern Alberta Clinic from 1998 to 2008. Of them, 404 (24.5 percent) had one or more neurologic disorders, and 41 percent of people with AIDS exhibited neurologic disease.
Most prevalent were symptomatic distal sensory polyneuropathy (10 percent) and HIV-associated neurocognitive disorder (HAND, 6.2 percent), wrote Dr. Chris Power, a professor at the universities of Alberta and Calgary, and colleagues.
Patients with at least one neurologic disorder exhibited higher mortality rates (17.6 percent vs. 8 percent, p<0.0001), and especially AIDS-related deaths (9.7 percent vs. 3.2 percent, p<0.0001), compared with those without neurologic disorders.
The mortality hazard ratio was calculated by Cox proportional hazard models and adjusted for demographic and clinical variables. The highest mortality hazard ratio was associated with opportunistic infections of the central nervous system, (HR 5.3, 95 percent confidence interval [CI] 2.5-11.2), followed by HAND (HR 3.1, 95 percent CI 1.8-5.3) and any neurologic disorder (HR 2.0, 95 percent CI 1.2-3.2).
"It's actually quite disturbing in the sense that he's reporting a significant number of people who are presenting with neurological disease related to HIV," said Montaner, director of the British Columbia Center for Excellence in HIV/AIDS. "An astonishing amount of the pathology that is being presented is actually preventable if we implement an aggressive strategy of what we call seek and treat."
Power said the problem may be that ARVs do not make it through to the nervous system in sufficient amounts to offset the consequences of HIV on the brain. Only a fraction makes it through, he said, noting that some are better than others. One solution might be to fine-tune existing therapies in order to enhance levels in the nervous system, he said.
The study, "Neurologic Disease Burden in Treated HIV/AIDS Predicts Survival," was published in Neurology (2010;75:1150-1158).
The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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