Highly active antiretroviral therapy access and neurological complications of human immunodeficiency virus infection: impact versus resources in Brazil.

Currently, there are almost 600,000 human immunodeficiency virus (HIV)-infected individuals in Brazil. From 1984 to 2004, 362,364 acquired immunodeficiency virus (AIDS) cases were officially reported and 155,000 patients are under highly active antiretroviral therapy (HAART) treatment. Like in developed countries, universal access to treatment in Brazil has definitively changed both mortality and morbidity of AIDS. Today, the median survival time is 58 months, with a 2-year survival of 63%, versus 18 months before HAART. As expected, the incidence of nervous system opportunistic infectious diseases and tumors has also decreased in Brazil. However, few Brazilian reports about neurological manifestations of HIV infection are available, particularly after the beginning of more effective antiretroviral therapy. Autopsy series report that toxoplasmosis is the most prevalent neurological disease, followed by cryptococcosis and HIV encephalitis. A much lower incidence of progressive multifocal leukoencephalopathy has been described in Brazil than in reports from developed countries. A possibility for this discrepancy could be differences in terms of JC virus (JCV) isolates or even the interactions between JCV and local HIV strains. Some particularities about the involvement of the nervous system in Brazilian patients are worthy of note, such as the occurrence of central nervous system involvement in chronic Chagas' disease in patients with AIDS, and the concomitance of leprosy and HIV infection. National surveillance of neurological manifestations of HIV infection is needed to ascertain the real impact of HAART on nervous system diseases associated with AIDS in Brazil.