Year: 2012
Type: article
Abstract: Despite 20 years of development, no practical vaccine for HIV is available, and HIV/AIDS remains a major health problem, with 33 million people infected and 2.6 million new infections in 2009. The infection is most prevalent in sub-Saharan Africa. Although rates of infection remain high, developments in antiretroviral regimens and changes in public health policy worldwide have significantly increased lifespans and changed the landscape of HIV complications, including the neurologic complications.
Prior to the availability of highly active antiretroviral therapy (HAART), neurologic disease was the heralding manifestation of AIDS in 7%–20% of patients and prevalence rates of neurologic infections varied from 39% to 70%. Following the introduction of HAART, neurologic disease declined significantly, particularly rates of CNS opportunistic infections (OI). Nonetheless, AIDS-related neurologic disease continues to represent a significant burden for developing countries. The spectrum of AIDS-related disease in many developing countries appears to parallel that reported in the pre-HAART era. In one study from Thailand conducted over 2 years, 2007–2008 inclusive,1 the most common CNS disorders in order of frequency were cryptococcal meningitis (37.8%), tuberculosis (TB) (35.8%), toxoplasmosis (12.8%), progressive multifocal leukoencephalopathy (4.1%), varicella zoster meningitis (2.7%), pneumococcal meningitis (1.4%), herpes simplex meningitis, and Epstein-Barr–related primary CNS lymphoma. Similarly, in South Africa, the CNS disorders observed have mirrored those seen in the pre-ART era in developed countries; a phenomenon attributed to the relative unavailability of antiretroviral therapy.2
Although incompletely investigated, it is widely believed that antiretroviral therapy has reduced the …
Source: Neurology
Authors: Dawson Dean, Joseph R. Berger
Institution: University of Kentucky
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2168912272