Inproceedings: an article in a conference proceedings.
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Establishment of a multi-disciplinary platform for HIV-infected patients with neurological complications.
Title of the conference
Scientific Abstract Listing of the 66th Annual Meeting,
American Academy of Neurology (AAN)
Philadelphia, PA, 26/4-3/05/2014.
OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro-HIV platform for HIV-infected patients in Switzerland. BACKGROUND: Despite the availability of combination antiretroviral therapy (cART), neurological complications, in particular the cognitive ones, remain a challenge in HIV-infected patients. Frequently, co-morbidities are intermingled with HIV, rendering the diagnostic and therapeutic procedures difficult in these patients. DESIGN/METHODS: In March 2011, we set up, at the Lausanne University Hospital, a multi-disciplinary Neuro-HIV Platform composed of infectiologists, neurologists, neuropsychologists, psychiatrists, and neuroradiologists. During a day-hospitalization, the patient benefits from a clinical evaluation by all these specialists, together with blood work-up, brain MRI and lumbar puncture. At the end of the day, diagnosis and treatment plan are discussed by the whole team. RESULTS: From March 2011 to September 2013, we evaluated 75 consecutive patients (49 men, 49.8±9.3 y, nadir CD4+ T cells 170.8±143.8 cells/mm3, current CD4+ 569.9±258 cells/mm3, 75% with undetectable plasma HIV RNA, 90% with undetectable CSF viral load, 99% on cART, revised CPE score 7.6±1.6). Main referral cause was cognitive complaints (89%), which were confirmed in 78% of those. The leading causes of cognitive disorders were psychiatric conditions (44% of all the confirmed) and HIV-associated neurocognitive disorders (HAND) (29%). Neurological deficits were evidenced in 47% of the total cohort (central signs in 20%; peripheral signs in 27%). Brain MRI was abnormal in 52%, mostly due to slight to moderate cortical/subcortical atrophy. The presence of HAND was correlated with a lower nadir CD4+ T cells (p=0.007). No other correlation was found between HIV disease status and neurological deficits. CONCLUSIONS: Neurological/neuropsychological complications are frequent in well-treated HIV+ patients, consisting mainly in cognitive disorders. The latter are more often ascribed to a psychiatric condition than to HIV infection itself. A multi-disciplinary approach is a real asset to take care of these complex patients.
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