Those patients had tuberculous meningitis or PML, mainly associated with unmasking IRIS. In 16 (14.5%) patients, HIV and CNS opportunistic infections Proteases inhibitor were diagnosed simultaneously. Thirty-one out of 94 (33%) patients with a previously known HIV infection were receiving HAART at the onset of CNS infection; 19 of them had detectable levels of serum HIV-1 viral load, mainly as a result of poor adherence. The annual incidence and the linear tendency are represented in Figure 1. The incidence of CNS opportunistic infections decreased from 9 cases per 1000 HIV-infected-patient-years in the ‘early HAART period’ to 3.8 in the

‘late HAART period’ (P = 0.04). When we calculated the incidence as the total number of cases per 1000 HIV-infected-patient on each period, there was a decrease from 49.5 cases in the early HAART period to 20.9 cases in the late HAART period (P < 0.001). During the study period, the proportion of patients on HAART in the overall cohort did not change significantly (75.7% vs. 77.2% in the early and late periods,

respectively). However, the proportion of patients with CD4 lymphocyte counts of < 200 cells/μL decreased from 17.7% to 10.1% and the proportion of patients with undetectable viral load increased from 64.1% to 78.6%. In Table 2 we show the incidences of the different CNS infections. Regarding the comparison between the early and late periods, the incidence of all CNS infections decreased significantly, except for PML, the incidence of which remained stable. The median duration of follow-up was 22 months (IQR 4–54 months). Thirty-four patients this website (31%) died and 32 (29%) were lost to follow-up during the study period. The two groups of patients were considered together in all survival analyses. At 3 months, 56 patients had clinical improvement and 16 remained stable. However, in 14 patients neurological damage worsened and 24 died or were lost to follow-up. In the early HAART period, 25 of 70 patients (35.7%) died compared with nine of 40 (22.5%) in the late HAART period (P = 0.15). Overall, the estimated mean survival time was 58.8 months [95% confidence interval (CI) 47.1–70.6 months]. The Kaplan–Meier estimates

of probability of survival were 79% (95% CI 71.5–86.7%) at 3 months, 71.8% (95% CI 63.4–80.2%) at 6 months, 61.7% (95% CI 52.7–70.7%) at 12 months, 48.3% (95% CI 38.9–57.7%) at 36 months and 36.7% Fludarabine nmr (95% CI 26.9–46.5%) at 60 months. The estimated median survival time expressed in months and the cumulative survival time for the different CNS opportunistic infections are shown in Figure 2. Differences in the survival time among the CNS infections did not reach statistical significance. Eighteen of 110 cases (16.4%) met the criteria of IRIS. Of these, 10 patients (55.6%) had PML. IRIS was diagnosed in four of 36 (11.1%) patients with cerebral toxoplasmosis, three of 21 (14.3%) with cryptococcal meningitis, one of 10 (10%) with tuberculous meningitis and 10 of 35 with PML (28.6%).