Incidence of Neurological Disorders among HIV-Infected Individuals with Universal Health Care in Taiwan from 2000 to 2010

Yi Tseng Tsai, Yen Chin Chen, Chen Yang Hsieh, Wen-Chien Ko, Nai-Ying Ko

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). Design: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000-2010. Methods: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age-adjusted and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population. Factors associated with neurological disorders were analyzed using a Cox proportional hazards model. Results: The standardized incidence of neurological disorders among HIV-infected persons increased from 22.16 per 1000 person-years in 2000 to 25.23 per 1000 person-years in 2010. Cognitive disorders increased significantly from 0.36 per 1000 person-years in 2001 to 7.44 per 1000 person-years in 2010 (trend P < 0.001). The rate of neurological disorders increased with age ≥55 years [adjusted hazard ratios (AHRs) 2.54, 95% confidence interval (CI): 1.89 to 3.40], hypertension (AHR 1.41, 95% CI: 1.12 to 1.76), substance abuse (AHR 1.65, 95% CI: 1.36 to 2.02), opportunistic infection (AHR 1.76, 95% CI: 1.47 to 2.11), syphilis (AHR 1.27, 95% CI: 1.10 to 1.47), and emergency department visits >5 (AHR 2.41, 95% CI: 1.96 to 2.97). The incidence of neurological disorders was negatively associated with adherence to HAART (adherence ≥85% AHR: 0.79, 95% CI: 0.64 to 0.97). Conclusions: The rising incidence of cognitive disorders among HIV-positive persons highlights the need to provide routine neurological evaluations at clinical visits. Receiving HAART with adherence ≥85% contributes to a reduced risk of neurological disorders.

Original languageEnglish
Pages (from-to)509-516
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume75
Issue number5
DOIs
Publication statusPublished - 2017 Aug 15

Fingerprint

Nervous System Diseases
Taiwan
HIV
Delivery of Health Care
Incidence
Highly Active Antiretroviral Therapy
National Health Programs
Proportional Hazards Models
Population
Cohort Studies
Databases
Research

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

@article{a862d92a74b04b1eb9be80c146c0b3cc,
title = "Incidence of Neurological Disorders among HIV-Infected Individuals with Universal Health Care in Taiwan from 2000 to 2010",
abstract = "Objective: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). Design: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000-2010. Methods: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age-adjusted and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population. Factors associated with neurological disorders were analyzed using a Cox proportional hazards model. Results: The standardized incidence of neurological disorders among HIV-infected persons increased from 22.16 per 1000 person-years in 2000 to 25.23 per 1000 person-years in 2010. Cognitive disorders increased significantly from 0.36 per 1000 person-years in 2001 to 7.44 per 1000 person-years in 2010 (trend P < 0.001). The rate of neurological disorders increased with age ≥55 years [adjusted hazard ratios (AHRs) 2.54, 95{\%} confidence interval (CI): 1.89 to 3.40], hypertension (AHR 1.41, 95{\%} CI: 1.12 to 1.76), substance abuse (AHR 1.65, 95{\%} CI: 1.36 to 2.02), opportunistic infection (AHR 1.76, 95{\%} CI: 1.47 to 2.11), syphilis (AHR 1.27, 95{\%} CI: 1.10 to 1.47), and emergency department visits >5 (AHR 2.41, 95{\%} CI: 1.96 to 2.97). The incidence of neurological disorders was negatively associated with adherence to HAART (adherence ≥85{\%} AHR: 0.79, 95{\%} CI: 0.64 to 0.97). Conclusions: The rising incidence of cognitive disorders among HIV-positive persons highlights the need to provide routine neurological evaluations at clinical visits. Receiving HAART with adherence ≥85{\%} contributes to a reduced risk of neurological disorders.",
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Incidence of Neurological Disorders among HIV-Infected Individuals with Universal Health Care in Taiwan from 2000 to 2010. / Tsai, Yi Tseng; Chen, Yen Chin; Hsieh, Chen Yang; Ko, Wen-Chien; Ko, Nai-Ying.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 75, No. 5, 15.08.2017, p. 509-516.

Research output: Contribution to journalArticle

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T1 - Incidence of Neurological Disorders among HIV-Infected Individuals with Universal Health Care in Taiwan from 2000 to 2010

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N2 - Objective: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). Design: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000-2010. Methods: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age-adjusted and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population. Factors associated with neurological disorders were analyzed using a Cox proportional hazards model. Results: The standardized incidence of neurological disorders among HIV-infected persons increased from 22.16 per 1000 person-years in 2000 to 25.23 per 1000 person-years in 2010. Cognitive disorders increased significantly from 0.36 per 1000 person-years in 2001 to 7.44 per 1000 person-years in 2010 (trend P < 0.001). The rate of neurological disorders increased with age ≥55 years [adjusted hazard ratios (AHRs) 2.54, 95% confidence interval (CI): 1.89 to 3.40], hypertension (AHR 1.41, 95% CI: 1.12 to 1.76), substance abuse (AHR 1.65, 95% CI: 1.36 to 2.02), opportunistic infection (AHR 1.76, 95% CI: 1.47 to 2.11), syphilis (AHR 1.27, 95% CI: 1.10 to 1.47), and emergency department visits >5 (AHR 2.41, 95% CI: 1.96 to 2.97). The incidence of neurological disorders was negatively associated with adherence to HAART (adherence ≥85% AHR: 0.79, 95% CI: 0.64 to 0.97). Conclusions: The rising incidence of cognitive disorders among HIV-positive persons highlights the need to provide routine neurological evaluations at clinical visits. Receiving HAART with adherence ≥85% contributes to a reduced risk of neurological disorders.

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