An IRIS diagnosis was made when all the following criteria were present: see more (1) recurrence of symptoms and signs of a previously identified and treated CNS infection (paradoxical IRIS) or new onset of clinical and neuroradiological findings (unmasking IRIS) within 6 months after HAART initiation, (2) a decrease in the plasma viral load of ≥ 1 log10 HIV-1 RNA copies/ml, and (3) the presence of symptoms not explained by a newly acquired disease, by the usual course of a previously acquired illness or by pharmacological toxicity [7-12, 18, 19]. The following data were recorded: demographic, clinical, laboratory, radiological and microbiological data,

antiretroviral therapy, clinical course and mortality. Patients were followed up until death or loss to follow-up or until

30 July 2011, when the database was closed. Incidences of CNS opportunistic diseases were estimated using as the denominator the number of HIV-infected persons alive registered in the database of our hospital, and were expressed as cases per 1000 HIV-infected people per year. In order to explore a change in the incidence trend during the study, two treatment periods were defined: the ‘early HAART period’, from 1 January 2000 to 31 June 2005, and the ‘late HAART period’, from 1 July 2005 to 31 December 2010. The incidence was calculated as the number of events per 1000 HIV-infected persons per year. Saracatinib To increase reliability, because the numbers learn more of patients with some of the infections studied were small, the incidence taking into account the total number of new cases of CNS infections on every period was also calculated. Statistical analyses were performed using the statistical software package spss for Windows, version 19.0 (SPSS, Chicago, IL). The significance of differences in mean incidences between the early and late HAART periods was determined using the Mantel–Haenszel test. Changes in incidences were reported with their associated 95% confidence intervals (CIs). Continuous variables are expressed as the median and interquartile range (IQR) or mean and standard deviation, as appropriate, and were

compared using the Student t-test or the Mann–Whitney U-test. Categorical variables were compared using the χ2 test or the Fisher exact test. The survival distribution was estimated using the Kaplan–Meier method. The comparison of survival between the different subject groups was performed using the log-rank test. A P-value < 0.05 was considered statistically significant. One hundred and ten patients with a CNS opportunistic infection were diagnosed between 2000 and 2010: 37 cases of cerebral toxoplasmosis, 23 of cryptococcal meningitis, 10 of tuberculous meningitis and 40 of PML. The baseline characteristics of the patients are shown in Table 1. The median CD4 lymphocyte count at diagnosis of CNS infection was 38 cells/μL (IQR 12–108 cells/μL).