8). The infection was newly identified after the initiation of HAART (unmasking IRIS) in eight out of 18 cases

(44.4%). In the remaining 10 cases (55.6%), IRIS was diagnosed after worsening of a previously treated CNS infection (paradoxical IRIS). The median interval from HAART initiation to diagnosis of IRIS was 39 days (IQR 20–90 days). Table 3 shows demographic, clinical and immunological characteristics of patients who developed paradoxical and unmasking IRIS. In order to identify pretreatment variables associated with the risk of developing paradoxical IRIS, these patients were compared with those who did not experience a paradoxical reaction. We found, as the only difference between the two groups, that patients who did not develop IRIS were more likely to have had a previous AIDS-defining condition (51.1% vs. 0% for those developing paradoxical IRIS; P = 0.002). Patients developing IRIS http://www.selleckchem.com/products/ganetespib-sta-9090.html had a more rapid immunological recovery than patients who did

not develop IRIS, as evidenced by a greater increase in CD4 count after AG-014699 order 3 months of antiretroviral therapy (ART) (170 vs. 62 cells/μL, respectively; P < 0.025). At this time-point, the decrease in viral load was also greater among patients with paradoxical IRIS, but differences did not reach statistical significance (–2.6 vs. −1.8 log10 for those with paradoxical IRIS; P = 0.10). Patients who began HAART within Branched chain aminotransferase 2 weeks after the diagnosis of a CNS infection were not at higher risk of developing paradoxical IRIS (50% vs. 65.8% for those who began HAART more than 2 weeks after diagnosis; P = 0.32). Figure 3 shows the cumulative probabilities of survival and the median survival time categorized by the development and type of IRIS. We did not find significant differences in survival between patients who developed paradoxical IRIS and those without IRIS. Eight (44.4%) of the 18 patients with IRIS received therapy

with steroids for a variable period depending on the response to therapy and other individual patient characteristics. None of the 10 patients who were not treated with steroids died, while three of the eight who received steroids died. In those three cases, mortality was directly attributed to IRIS. These three patients had PML. In our study, we observed a progressive decline in the incidence of CNS opportunistic infections during the first decade of the 21st Century. The overall rate of CNS infections decreased significantly from 8.3 cases per 1000 HIV-infected patients in the year 2000 to 1.4 in 2010. Since HAART became available, many studies have reported a decrease in the incidence of most opportunistic conditions related to HIV infection, including neurological infections [1-6, 20-22]. For example, a study performed in France by Abgrall et al. in 2001 showed a reduction of 34% in the risk of cerebral toxoplasmosis after the introduction of protease inhibitors [5].