8   Shift of Prevalence and Selected Characteristic in HIV-1- Related Neurologic Disorders in HAART Era: Data from Italian Register Investigative Neuro AIDS (IRINA).

A. Antinori*, A. Ammassari, P. Cinque, L. Toma, A. Govoni, F. Soldani, M. L. Giancola, S. Grisetti, C. Pierotti, C. Fausti, M. G. Finazzi, T. Bini, B. Del Grosso, L. Cristiano, P. Corsi, G. Fasulo, M. Mena, G. Guaraldi, M. I. Arcidiacono, L. Monno, B. Gigli, G. C. Fibbia, M. Gentile, A. Mastroianni, F. Speranza, A. d'Arminio Monforte, G. Rezza, and G. Ippolito.
Italian Register Investigative Neuro AIDS, Natl. Inst. of Infectious Diseases L. Spallanzani, Rome, Italy.

Background:This study involved evaluation of the prevalence, clinical characteristics, and relationship with antiretroviral therapy in newly registered HIV-1-related neurologic diseases in Italy.

Methods:Multicenter study conducted in 65 clinical centers from January 2000. Main characteristics at neurological diagnosis, HIV-1 disease and antiretroviral therapy histories were prospectively collected. Fisher's exact test for discrete and student t-test for continuous variable were employed for statistics.

Results:After 9 months of recruitment, 208 pts with HIV-1-related neurological diseases were registered, 99 (55%) HAART-experienced and 81 (45%) HAART-naive. A significant association was detected between IDU and TE (OR 042; 0.23—0.75) and IDU and CNS-NHL (OR n.c.; P = 0.02). At diagnosis mean CD4 count was 84 in naive and 120 cells/mm³in experienced ( P = 0.09), whereas HIV-1 RNA was 5.28 vs 4.27 log₁₀c/ml ( P = 0.0001), respectively. Among HAART-treated 84% had detectable viremia and 78% had <200 CD4 cells/mm³. Prevalence of single disorders according with HAART were 38.0% (naive) vs 22.5 (experienced) for TE (OR 0.47; 0.24—0.92; P = 0.04); 24.7% vs 14.6% for HIVE, 13.6 vs 11.1 for Cripto; 9.9 vs 12.1 for PML; 3.7 vs 5.1 for PCNSL; and 0 vs 8.1 for not determined leucoencephalitis (NDLE) (OR n.c; P = 0.0009). A significant association were observed between HIVE and HAART duration <24 wks (OR 3.47; 1.02—11.08; P = 0.05), whereas low HIV-1 RNA (<10.000 c/ml) was associated with NDLE (OR 7.73; 1.84—32.37; P = 0.005).

Conclusions:More than half of neurologic disorders occur in HAART-treated pts, even if most of them had a virological failure. Prevalence of HIV-1-related neurologic diseases substantially differs from that observed before HAART introduction, with a strong reduction of HIVE and PCNSL. TE remains the most prevalent picture mainly in naive pts and white matter encephalitis resulted emerging picture.