Central nervous system disorders afrer starting antiretroviral therapy in South Africa

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dc.contributor.authorAsselman, Valerie
dc.contributor.authorThienemann, Fredrich
dc.contributor.authorPepper, Dominique J
dc.contributor.authorBoulle, Andrew
dc.contributor.authorWilkinson, Robert J
dc.contributor.authorGraeme Meintjes
dc.contributor.authorMarais, Suzaan
dc.date.accessioned2016-08-17T13:31:52Z
dc.date.available2016-08-17T13:31:52Z
dc.date.issued2010
dc.date.updated2016-05-03T08:04:19Z
dc.description.abstractObjective: To describe the spectrum of central nervous system (CNS) disease during the first year of antiretroviral therapy (ART), and to determine the contribution of neurological immune reconstitution inflammatory syndrome (IRIS). Design: A prospective observational cohort study conducted over a 12-month period at a public sector referral hospital in South Africa. Methods: HIV seropositive patients who developed new or recurrent neurological or psychiatric symptom(s) or sign(s) within the first year of starting ART were enrolled. We used the number of patients starting ART in the referral area in the preceding year as the denominator to calculate the incidence of referral for neurological deterioration. Patients with delirium and peripheral neuropathy were excluded. Outcome at six months was recorded. Results: Seventy-five patients were enrolled. The median nadir CD4+ count was 64 cells/μL. 59% of patients were receiving antituberculosis treatment. The incidence of referral for CNS deterioration in the first year of ART was 23.3 cases (95% CI, 18.3–29.2) per 1000 patient years at risk. CNS tuberculosis (n=27, 36%), cryptococcal meningitis (n=18, 24%), intracerebral space occupying lesions (other than tuberculoma) (n=10, 13%) and psychosis (n=9, 12%) were the most frequent diagnoses. Paradoxical neurological IRIS was diagnosed in 21 patients (28%), related to tuberculosis in 16 and cryptococcosis in 5. At 6 months, 23% of patients had died and 20% were lost to follow-up. Conclusion: Opportunistic infections, notably tuberculosis and cryptococcosis, were the most frequent causes for neurological deterioration after starting ART. Neurological IRIS occurred in over a quarter of patients.
dc.identifierhttp://dx.doi.org/10.1097/QAD.0b013e328340fe76
dc.identifier10.1097/QAD.0b013e328340fe76
dc.identifier.apacitationAsselman, V., Thienemann, F., Pepper, D. J., Boulle, A., Wilkinson, R. J., , & Marais, S. (2010). Central nervous system disorders afrer starting antiretroviral therapy in South Africa. <i>AIDS</i>, http://hdl.handle.net/11427/21306en_ZA
dc.identifier.chicagocitationAsselman, Valerie, Fredrich Thienemann, Dominique J Pepper, Andrew Boulle, Robert J Wilkinson, , and Suzaan Marais "Central nervous system disorders afrer starting antiretroviral therapy in South Africa." <i>AIDS</i> (2010) http://hdl.handle.net/11427/21306en_ZA
dc.identifier.citationAsselman, V., Thienemann, F., Pepper, D. J., Boulle, A., Wilkinson, R. J., Meintjes, G., & Marais, S. (2010). Central nervous system disorders after starting antiretroviral therapy in South Africa. AIDS (London, England), 24(18).
dc.identifier.issn0269-9370
dc.identifier.ris TY - AU - Asselman, Valerie AU - Thienemann, Fredrich AU - Pepper, Dominique J AU - Boulle, Andrew AU - Wilkinson, Robert J AU - Graeme Meintjes AU - Marais, Suzaan AB - Objective: To describe the spectrum of central nervous system (CNS) disease during the first year of antiretroviral therapy (ART), and to determine the contribution of neurological immune reconstitution inflammatory syndrome (IRIS). Design: A prospective observational cohort study conducted over a 12-month period at a public sector referral hospital in South Africa. Methods: HIV seropositive patients who developed new or recurrent neurological or psychiatric symptom(s) or sign(s) within the first year of starting ART were enrolled. We used the number of patients starting ART in the referral area in the preceding year as the denominator to calculate the incidence of referral for neurological deterioration. Patients with delirium and peripheral neuropathy were excluded. Outcome at six months was recorded. Results: Seventy-five patients were enrolled. The median nadir CD4+ count was 64 cells/μL. 59% of patients were receiving antituberculosis treatment. The incidence of referral for CNS deterioration in the first year of ART was 23.3 cases (95% CI, 18.3–29.2) per 1000 patient years at risk. CNS tuberculosis (n=27, 36%), cryptococcal meningitis (n=18, 24%), intracerebral space occupying lesions (other than tuberculoma) (n=10, 13%) and psychosis (n=9, 12%) were the most frequent diagnoses. Paradoxical neurological IRIS was diagnosed in 21 patients (28%), related to tuberculosis in 16 and cryptococcosis in 5. At 6 months, 23% of patients had died and 20% were lost to follow-up. Conclusion: Opportunistic infections, notably tuberculosis and cryptococcosis, were the most frequent causes for neurological deterioration after starting ART. Neurological IRIS occurred in over a quarter of patients. DA - 2010 DB - OpenUCT DP - University of Cape Town J1 - AIDS KW - HIV KW - Neurological Disorders KW - Central Nervous System Diseases KW - Immune Reconstitution Inflammatory Syndrome KW - Antiretroviral Therapy LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 SM - 0269-9370 T1 - Central nervous system disorders afrer starting antiretroviral therapy in South Africa TI - Central nervous system disorders afrer starting antiretroviral therapy in South Africa UR - http://hdl.handle.net/11427/21306 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/21306
dc.identifier.vancouvercitationAsselman V, Thienemann F, Pepper DJ, Boulle A, Wilkinson RJ, , et al. Central nervous system disorders afrer starting antiretroviral therapy in South Africa. AIDS. 2010; http://hdl.handle.net/11427/21306.en_ZA
dc.language.isoeng
dc.publisherLippincott, Williams & Wilkins
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceAIDS
dc.source.urihttp://www.lww.com/product/?0269-9370
dc.subjectHIV
dc.subjectNeurological Disorders
dc.subjectCentral Nervous System Diseases
dc.subjectImmune Reconstitution Inflammatory Syndrome
dc.subjectAntiretroviral Therapy
dc.titleCentral nervous system disorders afrer starting antiretroviral therapy in South Africa
dc.typeJournal Article
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