ArticleAIDS (London, England)2010
Central nervous system disorders after starting antiretroviral therapy in South Africa.
Article in AIDS (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.The Pediatric infectious disease journal · 2013Guideline
- Article
- Advances in Antiretroviral Therapy for Patients with Human Immunodeficiency Virus-Associated Tuberculosis.Viruses · 2024Review
- The COVID-19 pandemic: new challenges for the mental health protection system.Postepy psychiatrii neurologii · 2023Review
- Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease.Life (Basel, Switzerland) · 2020Review
- Global HIV neurology: a comprehensive review.AIDS (London, England) · 2019Review
- HIV and mental illness in Malawi and the neuropsychiatric sequelae of efavirenz.Malawi medical journal : the journal of Medical Association of Malawi · 2018Review
- Brief Report: Late Efavirenz-Induced Ataxia and Encephalopathy: A Case Series.Journal of acquired immune deficiency syndromes (1999) · 2017Article
- Inflammasome Activation Underlying Central Nervous System Deterioration in HIV-Associated Tuberculosis.The Journal of infectious diseases · 2017Observational
- HIV-1 tuberculosis-associated immune reconstitution inflammatory syndrome.Seminars in immunopathology · 2016Review
- Interleukin-17 mediated differences in the pathogenesis of HIV-1-associated tuberculous and cryptococcal meningitis.AIDS (London, England) · 2016Observational
- First-line antiretroviral therapy durability in a 10-year cohort of naïve adults started on treatment in Uganda.Journal of the International AIDS Society · 2016Article
- Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Review
- Spinal cord involvement in tuberculous meningitis.Spinal cord · 2015Review
- New insights into immune reconstitution inflammatory syndrome of the central nervous system.Current opinion in HIV and AIDS · 2014Review
- [Acute psychosis as a side effect of efavirenz therapy with metabolic anomalies: an important differential diagnosis of HIV-associated psychoses].Der Nervenarzt · 2014Article
- Treatment and outcomes among patients with Cryptococcus gattii infections in the United States Pacific Northwest.PloS one · 2014Article
- Central nervous system immune reconstitution inflammatory syndrome.Current infectious disease reports · 2013Article
- T-cell reconstitution during murine acquired immunodeficiency syndrome (MAIDS) produces neuroinflammation and mortality in animals harboring opportunistic viral brain infection.Journal of neuroinflammation · 2013Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveTo 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).
designA prospective observational cohort study conducted over a 12-month period at a public sector referral hospital in South Africa.
methodsHIV-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 6 months was recorded.
resultsSeventy-five patients were enrolled. The median nadir CD4(+) cell counts was 64 cells/μl. Fifty-nine percent of the patients were receiving antituberculosis treatment. The incidence of referral for CNS deterioration in the first year of ART was 23.3 cases [95% confidence interval (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 five. At 6 months, 23% of the patients had died and 20% were lost to follow-up.
conclusionOpportunistic 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.
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