17 November 2012
HIV-positive men who have sex with men (MSM) on antiretroviral therapy (ART) had neurologic disease at a younger age than HIV-negative MSM at risk for HIV infection in the US Multicenter AIDS Cohort Study (MACS). Compared with the HIV-negative group, HIV-positive men had significantly higher rates of four types of neurologic disease, including dementia.
High rates of neurologic disease persist in HIV-positive people despite access to combination ART. MACS investigators conducted this study to compare incidence and patterns of neurologic disease in HIV-positive MACS members and HIV-negative men in the cohort. MACS is an ongoing prospective study of MSM in four US cities.
The analysis involved 1776 HIV-positive men and 2083 HIV-negative men studied in the combination ART era, beginning 1 July 1996. Follow-up continued until 1 July 2011, the last follow-up visit for each man, or death. During follow-up, 86 HIV-negative men became positive.
Median age at first neurologic diagnosis was significantly younger in HIV-positive men on ART than in HIV-negative men (48 versus 54 years, P < 0.001). Neurologic disease incidence (the new diagnosis rate) was higher in antiretroviral-treated HIV-positive men than in HIV-negative men in every age group:
• Younger than 40: 11.4 vs 0 diagnoses per 1000 person-years (P < 0.001)
• 40 to 49 years: 11.6 vs 2.0 (P < 0.001)
• 50 to 60 years: 15.1 vs 3.0 (P < 0.001)
• Older than 60: 17.0 vs 5.7 (P < 0.01)
Four types of neurologic disease affected HIV-positive men on ART more than HIV-negative men: nervous system infections (P < 0.001), dementia (P < 0.001), seizures/epilepsy (P < 0.01), and peripheral nervous system disorders (P < 0.001). Stroke was not more frequent in men with HIV (P = 0.60).
The MACS team proposes that “the higher burden of neurologic disorders experienced in HIV-positive MSM represents potentially treatable and preventable neurologic disease.”
The investigators believe that “middle-aged and elderly HIV-positive individuals require in-depth clinical studies to fully understand the various mechanisms that may contribute to their excess burden of neurologic disease.”
Source: Farrah J. Mateen, Russell T. Shinohara, Marco Carone, Eric N. Miller, Justin C. McArthur, Lisa P. Jacobson, Ned Sacktor, for the Multicenter AIDS Cohort Study. Neurologic disorders incidence in HIV+ vs HIV− men: Multicenter AIDS Cohort Study, 1996–2011. Neurology. 2012; 79: 1873-1880.
For the complete article