Scientific Evidences of Neurologic Disabilities in AIDS Patients

1

• Scientific Evidences of Neurologic Disabilities
  in AIDS Patients
• José E. Vidal, M.D., Ph.D
• Instituto de Infectologia Emílio Ribas SP -
  Brasil
• Universidade de São Paulo SP - Brasil

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Neurological affections - HIV

• 30 90
• (Harrison McArthur, 1995)
• First manifestation 20
• (Comblain et al., 2005)

3

• HIV Neurology
• High complexity management
• Functional Impact
• (Harrison
  McArthur, 1995)

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Primary HIV-related

• Secondary
• (Price RW. AIDS Medicine, 1989)

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Incidence of CNS-Diseases during follow-up
100
Non CNS-D (40 decline/year)
10
Incidence per 100 PYFU (95CI)
CNS-D (40 decline/year)
1
0,1
1994
1995
1996
1997
1998
1999
2000
2001
dArminio Monforte et al. Ann Neurol
200455320-8
6
McArthur et al. J Neurovirol 20039205-21
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HAART ERA - DEVELOPED COUNTRIES

• Important reduction in morbidity and mortality in
  patients with AIDS
• (Hogg RS et al., 1998)

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HIV-associated neurocognitive disorders

• Asymptomatic neurocognitive impairment
• HIV-associated mild neurocognitive disorder
• HIV-associated dementia
• 
  Antinori A et al. Neurology 2007691789-99

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Change in the Natural History of ADC in HAART
era CD4 cell count disconnect
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HIV-related Peripheral Neuropathies
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HIV/AIDS World Epidemic

• Underdeveloped nations - 90 of AIDS cases
• - 95
  0f New Cases
• (UNAIDS/WHO, 2007)

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People living with HIV, Brazil 2005
600,000 people living with HIV (2004 estimated
from 15 to 49 years-old)
197,000 (33) Most of them are not aware of
his/ her HIV status
403,000 (67) Diagnosed cases
225,000 Off therapy
178,000 On ARV therapy
Risk of opportunistic diseases, including CNS
complications
DATASUS, SIH
Brazilian National STD/AIDS Program
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Clinical studies in the HAART era
2 Oliveira JF et al. Rev Soc Bras
Med Trop 200639146-51 3 Vidal et al. Rev Inst
Med Trop S Paulo (in press)
Hisotlogy confirmed PCR () in CSF and in
brain
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Prevalence of cerebral toxoplasmosis in Sao Paulo
20
10

Epidemiology Service -
CRT/AIDS - Sao Paulo
Year
15
Impact of HAART on incidence of cerebral
toxoplasmosis
1Abgrall et al. Clin Infect Dis
2001331747-55 2Gaspar et al. 14th International
AIDS Conference. 2002. Abstract
ThPeC7458 3Guimarães. Cad Saúde Pública
200016(Suppl 1)21-36
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Clinical outcome of 55 AIDS patients with TE
n 55
Deaths n 3
Partial response n 36
Complete response n 16
D 14
TE 2 NI 1
13
Partial response n 25
Complete response n 23
Deaths n 4
D 42
NI 4
48
Deaths n 2
PCP 1 IPD 1
Partial response n 21
Complete response n 23
1 YEAR
Vidal et al. AIDS Patient Care and STD
2005
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Neurologic clinical series at IIER, São Paulo
Vidal et al. 2005 Andrade et al. 2007
Poliseli et al. 2007 Croda et al. 2007
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Syndromic Approach of Opportunistic CNS Diseases
in HIV-infected Patients
Predominant syndrome
Meningeal syndrome
Encephalopathy
1. Cryptococcosis 2. Tuberculosis 3. Syphilis
Focal
Diffuse
1. HIV 2. PML 3. CMV 4. VZV 5. HSV
With mass effect 1. Toxoplasmosis 2.
Tuberculosis 3. PCNSL 4. Bacterial abscess 5.
Chagas disease
Without mass effect 1. PML 2. CMV 3. VZV 4. HSV
Emilio Ribas Institute of Infectious Diseases,
2006
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Algoritmo diagnóstico das lesões cerebrais focais
em pacientes HIV
Lesão expansiva / Captação de contraste/ (TC/RM)
- LEMP - EOI - outras
SIM
NÃO
IgG anti- T. gondii / PCR s
Toxoplasmose cerebral
-

• Tuberculose
• LPSNC
• outras

Prova terapêutica (2 semanas)
LCR se possível
IIER, 2006
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Transporting advances in neurological
complications of HIV/AIDS

• developed
• countries
• socio-economic limitations
• Same country, different worlds

• Latin America

Addapted from Cinque P et al. J
Neurovirol 2005(Suppl. 3)1-5
Human Developmen Report 2006.
UNDP
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Neurological complications of HIV/AIDS
Addapted from Cinque P et al. J
Neurovirol 2005(Suppl. 3)1-5
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HIV-associated Neurological Diseases are common
despite HAART

• Remains a considerable concern to HIV-infected
  patients
• Cause of disabilities
• Specific Programs, including focus in disabilities

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