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Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

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Abstract

The introduction of highly active anti-retroviral therapy (HAART) led to a radical change in the natural history of HIV infection and of the associated neurological opportunistic infections. However, the mortality of central nervous system (CNS) complications and opportunistic infections is still high in untreated HIV-infected individuals or in patients unaware of their HIV infection. We describe the outcome of HIV-infected patients followed at a single center for AIDS-related neurological syndromes in the 16 years following the introduction of HAART, and compare the findings with those in patients admitted up to 1996. We have conducted a retrospective study of patients with HIV infection or AIDS (based on WHO criteria and classified according to the 1993 CDC criteria) admitted during 20 years (January 1992 to March 2012) to the Infectious Diseases Unit of the University of Verona for the presence of focal or widespread CNS lesion on neuroimaging. Clinical history, CD4 cell count, HIV-RNA level, neurological examination, imaging, cerebrospinal fluid examination and eventual cerebral biopsy results were reviewed as well as the final neurological diagnosis and the treatment. The survival time from the clinical onset of the neurologic syndrome to death was calculated for each patient who died. A statistical analysis was performed comparing data collected up to and after 1996, i.e., before and after HAART introduction. Among 1043 patients with HIV infection or AIDS admitted to the Infectious Diseases Unit of the University of Verona between January 1992 and March 2012, 114 had a CNS lesion. The following diseases were observed: neurotoxoplasmosis (NT), progressive multifocal leukoencephalopathy), primary central nervous system lymphoma (PCNSL), the severe form of HIV-associated neurocognitive disorder, cryptococcal encephalitis (CE) and lesions of undetermined origin. The follow-up period was 4 weeks to 72 months both in the pre-HAART and HAART era. Cerebral lesions were detected in 53/243 patients (21.8 %) in the pre-HAART era and in 61/801 patients (7.6 %) in the HAART era (p < 0.001). Most patients who developed a neurological complication in the HAART period (40/59, 67.8 %) were untreated or did not know to be HIV-infected; in particular, 27.9 % of patients with a CNS lesion in the HAART era were unaware of their HIV infection vs 13.2 % in the pre-HAART era (p < 0.05). Some patients were not virologically suppressed (14/59, 23.7 %) or were immunological non-responders (undetectable viral load, with CD4 count <200 cells/μL; 4/59, 6.8 %). Other statistically significant data were the mean age at the onset of neurological complications (32.6 ± 5.4 years in the pre-HAART, 40.3 ± 9.5 in the HAART group, p < 0.001) and the mean CD4 cell count at the onset of illness (median of 38 cells/µL (2–215) in the pre-HAART, 77 cells/µL (2–752) in the HAART group; p < 0.001). In the HAART era a reduction of PCNSL and NT was observed. Our results, while confirming a decrease in the incidence of opportunistic infections of the CNS in the HAART era, show that late presentation of patients with HIV infection remains an important issue in our catchment area.

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References

  1. UNAIDS Global report (2010) UNAIDS report on the global AIDS epidemic, 2010. Geneva: Joint United Nation Programme on HIV/AIDS http://issuu.com/unaids/docs/unaids_globalreport_2010?e=2251159/2047939

  2. UK Collaborative HIV Cohort (CHIC) Study Steering Committee, Garvey L, Winston A, Walsh J, Post F, Porter K, Gazzard B, Fisher M, Leen C, Pillay D, Hill T, Johnson M, Gilson R, Anderson J, Easterbrook P, Bansi L, Orkin C, Ainsworth J, Phillips AN, Sabin CA (2011) HIV-associated central nervous system diseases in the recent combination antiretroviral therapy era. Eur J Neurol 18:527–534

    Article  Google Scholar 

  3. d’Arminio Monforte A, Cinque P, Mocroft A, Goebel FD, Antunes F, Katlama C, Justesen US, Vella S, Kirk O, Lundgren J (2004) EuroSIDA Study Group. Changing incidence of central nervous system diseases in the EuroSIDA cohort. Ann Neurol 55:320–328

    Article  PubMed  Google Scholar 

  4. Sacktor N, Lyles RH, Skolasky R, Kleeberger C, Selnes OA, Miller EN, Becker JT, Cohen B, McArthur JC, Multicenter AIDS Cohort Study (2001) HIV-associated neurologic disease incidence changes: multicenter AIDS Cohort Study, 1990–1998. Neurology 56:257–260

    Article  CAS  PubMed  Google Scholar 

  5. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–1799

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Lindl KA, Marks DR, Kolson DL, Jordan-Sciutto KL (2010) HIV-Associated Neurocognitive Disorder: pathogenesis and Therapeutic Opportunities. J Neuroimmune Pharmacol 5:294–309

    Article  PubMed Central  PubMed  Google Scholar 

  7. McArthur JC (2004) HIV dementia: an evolving disease. J Neuroimmunol 157:3–10

    Article  CAS  PubMed  Google Scholar 

  8. Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I, For the CHARTER Group (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy. CHARTER study. Neurology 75:2087–2096

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Clifford DB, Ances BM (2013) HIV-associated neurocognitive disorder. Lancet Infect Dis 13:976–986

    Article  PubMed Central  PubMed  Google Scholar 

  10. Mocroft AJ, Lundgren JD, d’ArminoMonforte A, Ledergerber B, Barton SE, Vella S, Katlama C, Gerstoft J, Pedersen C, Phillips AN (1997) Survival of AIDS patients according to type of AIDS-defining event. The AIDS in Europe Study Group. Int J Epidemiol 26:400–407

    Article  CAS  PubMed  Google Scholar 

  11. Centers for Disease Control and prevention (1993) Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR Recomm Rep 41:1–19

    Google Scholar 

  12. Portegies P, Enting RH, de Gans J, Algra PR, Derix MM, Lange JM, Goudsmit J (1993) Presentation and course of AIDS dementia complex: 10 years of follow-up in Amsterdam, The Netherlands. AIDS 7:669–675

    Article  CAS  PubMed  Google Scholar 

  13. Ammassari A, Scoppettuolo G, Murri R, Pezzotti P, Cingolani A, Del Borgo C, De Luca A, Antinori A, Ortona L (1998) Changing disease patterns in focal brain lesion-causing disorders in AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 18:365–371

    Article  CAS  PubMed  Google Scholar 

  14. Clifford DB, Yiannoutsos C, Glicksman M, Simpson DM, Singer EJ, Piliero PJ, Marra CM, Francis GS, McArthur JC, Tyler KL, Tselis AC, Hyslop NE (1999) HAART improves prognosis in HIV-associated progressive multifocal leukoencephalopathy. Neurology 52:623–625

    Article  CAS  PubMed  Google Scholar 

  15. Tassie JM, Gasnault J, Bentata M, Deloumeaux J, Boué F, Billaud E, Costagliola D (1999) Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors. Clinical Epidemiology Group. French Hospital Database on HIV. AIDS 13:1881–1887

    Article  CAS  PubMed  Google Scholar 

  16. Ammassari A, Cingolani A, Pezzotti P, De Luca DA, Murri R, Giancola ML, Larocca LM, Antinori A (2000) AIDS-related focal brain lesions in the era of highly active antiretroviral therapy. Neurology 55:1194–1200

    Article  CAS  PubMed  Google Scholar 

  17. Maschke M, Kastrup O, Esser S, Ross B, Hengge U, Hufnagel A (2000) Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry 69:376–380

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Abgrall S, Rabaud C, Costagliola D, Clinical Epidemiology Group of the French Hospital Database on HIV (2001) Incidence and risk factors for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active antiretroviral therapy era. Clin Infect Dis 33:1747–1755

    Article  CAS  PubMed  Google Scholar 

  19. Berenguer J, Miralles P, Arrizabalaga J, Ribera E, Dronda F, Baraia-Etxaburu J, Domingo P, Márquez M, Rodriguez-Arrondo FJ, Laguna F, Rubio R, Lacruz Rodrigo J, Mallolas J, de Miguel V, GESIDA 11/99 Study Group (2003) Clinical course and prognostic factors of progressive multifocal leukoencephalopathy in patients treated with highly active antiretroviral therapy. Clin Infect Dis 36:1047–1052

    Article  CAS  PubMed  Google Scholar 

  20. Antinori A, Larussa D, Cingolani A, Lorenzini P, Bossolasco S, Finazzi MG, Bongiovanni M, Guaraldi G, Grisetti S, Vigo B, Gigli B, Mariano A, Dalle Nogare ER, De Marco M, Moretti F, Corsi P, Abrescia N, Rellecati P, Castagna A, Mussini C, Ammassari A, Cinque P, d’Arminio Monforte A (2004) Italian Registry Investigative NeuroAIDS. Prevalence, associated factors, and prognostic determinants of aids-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy. Clin Infect Dis 39:1681–1691

    Article  PubMed  Google Scholar 

  21. Diamond C, Taylor TH, Im T, Miradi M, Wallace M, Anton-Culver H (2006) Highly active antiretroviral therapy is associated with improved survival among patients with AIDS-related primary central nervous system non-Hodgkin’s lymphoma. Curr HIV Res 4:375–378

    Article  CAS  PubMed  Google Scholar 

  22. Lipman M, Breen R (2006) Immune reconstitution inflammatory syndrome in HIV. Curr Opin Infect Dis 19:20–25

    Article  PubMed  Google Scholar 

  23. Hessol NA, Pipkin S, Schwarcz S, Cress RD, Bacchetti P, Scheer S (2007) The impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDS. Am J Epidemiol 165:1143–1153

    Article  PubMed  Google Scholar 

  24. Falcó V, Olmo M, del Saz SV, Guelar A, Santos JR, Gutiérrez M, Colomer D, Deig E, Mateo G, Montero M, Pedrol E, Podzamczer D, Domingo P, Llibre JM (2008) Influence of HAART on the clinical course of HIV-1-infected patients with progressive multifocal leukoencephalopathy: results of an observational multicenter study. J Acquir Immune Defic Syndr 49:26–31

    Article  PubMed  Google Scholar 

  25. Shiels MS, Cole SR, Kirk GD, Poole C (2009) A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 52:611–622

    Article  PubMed Central  PubMed  Google Scholar 

  26. Marzocchetti A, Tompkins T, Clifford DB, Gandhi RT, Kesari S, Berger JR, Simpson DM, Prosperi M, De Luca A, Koralnik IJ (2009) Determinants of survival in progressive multifocal leukoencephalopathy. Neurology 73:1551–1558

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Tambussi G, Gori A, Capiluppi B, Balotta C, Papagno L, Morandini B, Di Pietro M, Ciuffreda D, Saracco A, Lazzarin A (2000) Neurological symptoms during primary human immunodeficiency virus (HIV) infection correlate with high levels of HIV RNA in cerebrospinal fluid. Clin Infect Dis 30:962–965

    Article  CAS  PubMed  Google Scholar 

  28. Christo PP, Greco DB, Aleixo AW, Livramento JA (2005) HIV-1 RNA levels in cerebrospinal fluid and plasma and their correlation with opportunistic neurological diseases in a Brazilian AIDS reference hospital. Arq Neuropsiquiatr 63:907–913

    PubMed  Google Scholar 

  29. Canestri A, Lescure FX, Jaureguiberry S, Moulignier A, Amiel C, Marcelin AG, Peytavin G, Tubiana R, Pialoux G, Katlama C (2010) Discordance between cerebral spinal fluid and plasma HIV replication in patients with neurological symptoms who are receiving suppressive antiretroviral therapy. Clin Infect Dis 50:773–778

    Article  PubMed  Google Scholar 

  30. Luft BJ, Brooks RG, Conley FK, McCabe RE, Remington JS (1984) Toxoplasmic encephalitis in patients with acquired immune deficiency syndrome. JAMA 252:913–917

    Article  CAS  PubMed  Google Scholar 

  31. Torok ME (2005) Human immunodeficiency virus associated central nervous system infection. Practical Neurology 5:334–3494

    Article  Google Scholar 

  32. Cinque P, Koralnik IJ, Gerevini S, Miro JM, Price RW (2009) Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect Dis 9:625–636

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Riveiro-Barciela M, Falcó V, Burgos J, Curran A, Van den Eynde E, Navarro J, Villar del Saz S, Ocaña I, Ribera E, Crespo M, Pahissa A (2013) Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital. HIV Med 14:21–30

    Article  CAS  PubMed  Google Scholar 

  34. Tan K, Roda R, Ostrow L, McArthur J, Nath A (2009) PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids. Neurology 72:1458–1464

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. González-Scarano F, Martín-García J (2005) The neuropathogenesis of AIDS. J Nat Rev Immunol 5:69–81

    Article  Google Scholar 

  36. Janssen RS, Cornblath DR, Epstein LG et al (1991) Nomenclature and research case definitions for neurological manifestations of human immunodeficiency virus type-1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology 41:778–785

    Article  Google Scholar 

  37. Mind Exchange Working Group (2013) Assessment, diagnosis, and treatment of HIV-associated neurocognitive disorder: a consensus report of the mind exchange program. Clin Infect Dis 56:1004–1017

    Article  Google Scholar 

  38. Valcour VG (2011) Evaluating cognitive impairment in the clinical setting: practical screening and assessment tools. Top Antivir Med 19:175–180

    PubMed  Google Scholar 

  39. Overton ET, Kauwe JS, Paul R, Tashima K, Tate DF, Patel P, Carpenter CC, Patty D, Brooks JT, Clifford DB (2011) Performances on the CogState and standard neuropsychological batteries among HIV patients without dementia. AIDS Behav 15:1902–1909

    Article  PubMed Central  PubMed  Google Scholar 

  40. Overton ET, Azad TD, Parker N, Demarco Shaw D, Frain J, Spitz T, Westerhaus E, Paul R, Clifford DB, Ances BM (2013) The Alzheimer’s disease-8 and Montreal Cognitive Assessment as screening tools for neurocognitive impairment in HIV-infected persons. J Neurovirol 19:109–116

    Article  PubMed Central  PubMed  Google Scholar 

  41. Chalermchai T, Valcour V, Sithinamsuwan P, Pinyakorn S, Clifford D, Paul RH, Tipsuk S, Fletcher JL, Degruttola V, Ratto-Kim S, Hutchings N, Shikuma C, Ananworanich J, SEARCH 007 and 011 study groups (2013) Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND. J Neurovirol 19:137–143

    Article  PubMed Central  PubMed  Google Scholar 

  42. Ellis RJ, Evans SR, Clifford DB, Moo LR, McArthur JC, Collier AC, Benson C, Bosch R, Simpson D, Yiannoutsos CT, Yang Y, Robertson K, Neurological AIDS Research Consortium; AIDS Clinical Trials Group Study Teams A5001 and A362 (2005) Clinical validation of the neuroscreen. J Neurovirol 11:503–511

    Article  PubMed  Google Scholar 

  43. Janssen RS, Nwanyanwu OC, Selik RM, Stehr-Green JK (1992) Epidemiology of human immunodeficiency virus encephalopathy in the United States. Neurology 42:1472–1476

    Article  CAS  PubMed  Google Scholar 

  44. McArthur J, Grant I (1998) HIV neurocognitive disorders. In: Gendelman H, Lipton S, Epstein L, Swindells S (eds) The Neurology of AIDS. International Thompson Publishing, New York, pp 499–523

    Google Scholar 

  45. McArthur JC, Steiner J, Sacktor N, Nath A (2010) Human immunodeficiency virus-associated neurocognitive disorders: mind the gap. Ann Neurol 67:699–714

    CAS  PubMed  Google Scholar 

  46. Stout JC, Ellis RJ, Jernigan TL, Archibald SL, Abramson I, Wolfson T, McCutchan JA, Wallace MR, Atkinson JH, Grant I, HIV Neurobehavioral Research Center Group (1998) Progressive cerebral volume loss in human immunodeficiency virus infection: a longitudinal volumetric magnetic resonance imaging study. Arch Neurol 55:161–168

    Article  CAS  PubMed  Google Scholar 

  47. Küper M, Rabe K, Esser S, Gizewski ER, Husstedt IW, Maschke M, Obermann M (2011) Structural gray and white matter changes in patients with HIV. J Neurol 258:1066–1075

    Article  PubMed  Google Scholar 

  48. Devlin KN, Gongvatana A, Clark US, Chasman JD, Westbrook ML, Tashima KT, Navia B, Cohen RA (2012) Neurocognitive effects of HIV, hepatitis C, and substance use history. J Int Neuropsychol Soc 18:68–78

    Article  PubMed Central  PubMed  Google Scholar 

  49. Zhang L, Looney D, Taub D, Chang SL, Way D, Witte MH, Graves MC, Fiala M (1998) Cocaine opens the blood-brain barrier to HIV-1 invasion. J Neurovirol 4:619–626

    Article  CAS  PubMed  Google Scholar 

  50. Silverstein PS, Shah A, Weemhoff J, Kumar S, Singh DP, Kumar A (2012) HIV-1 gp120 and drugs of abuse: interactions in the central nervous system. Curr HIV Res 10:369–383

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Buch S, Yao H, Guo M, Mori T, Mathias-Costa B, Singh V, Seth P, Wang J, Su TP (2012) Cocaine and HIV-1 interplay in CNS: cellular and molecular mechanisms. Curr HIV Res 10:425–428

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Clifford DB, Evans SR, Yang Y, Gulick RM (2005) The neuropsychological and neurological impact of hepatitis C virus co-infection in HIV-infected subjects. AIDS 19(suppl 3):S64–S71

    Article  PubMed  Google Scholar 

  53. Forton DM, Allsop JM, Cox IJ, Hamilton G, Wesnes K, Thomas HC, Taylor-Robinson SD (2005) A review of cognitive impairment and cerebral metabolite abnormalities in patients with hepatitis C infection. AIDS 19(Suppl 3):S53–S63

    Article  PubMed  Google Scholar 

  54. Cherner M, Letendre S, Heaton RK, Durelle J, Marquie-Beck J, Gragg B, Grant I, HIV Neurobehavioral Research Center Group (2005) Hepatitis C augments cognitive deficits associated with HIV infection and methamphetamine. Neurology 64:1343–1347

    Article  CAS  PubMed  Google Scholar 

  55. Hilsabeck RC, Castellon SA, Hinkin CH (2005) Neuropsychological aspects of coinfection with HIV and hepatitis C virus. Clin Infect Dis 41(suppl 1):S38–S44

    Article  PubMed Central  PubMed  Google Scholar 

  56. Ryan EL, Morgello S, Isaacs K, Naseer M, Gerits P (2004) Neuropsychiatric impact of hepatitis C on advanced HIV. Neurology 62:957–962

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Forton DM, Hamilton G, Allsop JM, Grover VP, Wesnes K, O’Sullivan C, Thomas HC, Taylor-Robinson SD (2008) Cerebral immune activation in chronic hepatitis C infection: a magnetic resonance spectroscopy study. J Hepatol 49:316–322

    Article  CAS  PubMed  Google Scholar 

  58. Wright EJ, Grund B, Robertson K, Brew BJ, Roediger M, Bain MP, Drummond F, Vjecha MJ, Hoy J, Miller C, Penalva de Oliveira AC, Pumpradit W, Shlay JC, El-Sadr W, Price RW, INSIGHT SMART Study Group (2010) Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 75:864–873

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Becker JT, Kingsley L, Mullen J, Cohen B, Martin E, Miller EN, Ragin A, Sacktor N, Selnes OA, Visscher BR (2009) Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men. Neurology 73:1292–1299

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  60. McCutchan JA, Marquie-Beck JA, Fitzsimons CA, Letendre SL, Ellis RJ, Heaton RK, Wolfson T, Rosario D, Alexander TJ, Marra C, Ances BM, Grant I, For the CHARTER Group (2012) Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology 78:485–492

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM (2009) Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 23:525–530

    Article  PubMed  Google Scholar 

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Conflicts of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Ethical standard

The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Given the observational and retrospective design of the study patient consent collection and ethics committee approval were not applicable according to our Institution policy. All patients data were anonymized before statistical analysis.

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Authors and Affiliations

  1. Section of Neurology, Department of Neurological and Movement Sciences, “G.B. Rossi” University Hospital, University of Verona, Verona, Italy

    Angela Matinella, M. A. Bonometti, A. Gajofatto, S. Monaco & S. Ferrari

  2. Infectious Diseases Unit, “G.B. Rossi” University Hospital, Verona, Italy

    M. Lanzafame & E. Concia

  3. Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana

    S. Vento

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  1. Angela Matinella
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Matinella, A., Lanzafame, M., Bonometti, M.A. et al. Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study. J Neurol 262, 1317–1327 (2015). https://doi.org/10.1007/s00415-015-7713-8

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