HIV infection may protect against multiple sclerosis

1.  In this study cohort, patients who were HIV positive had a lower risk of developing multiple sclerosis. 

2. This report complements the ongoing clinical trial using Raltegravir to treat relapsing-remitting multiple sclerosis. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Cases of patients infected with Human Immunodeficiency Virus (HIV) with co-morbid multiple sclerosis (MS) are sparse in the literature. However, several case reports have shown significant decrease in MS symptoms with the initiation of anti-retroviral therapy (ART). This study used a data set of English Hospital Episode Statistics derived from National Health Services hospitals to compare cohorts of HIV positive and negative patients and their subsequent incidence of MS. The authors found a significant decrease of MS incidence in patients with HIV compared to controls. While the association between HIV and lower MS risk is strong, the study was unable to comment on causality. It is also still unknown whether the immunosuppressed condition of HIV patients, or the initiation of ART is responsible for the reduced risk. These data support the rationale behind a current clinical trial examining the efficacy of the anti-retroviral Raltegravir in treating relapsing-remitting MS. This study is also robust in sample size and avoids the pitfall of a previous Danish study that was unable to significantly demonstrate the above association largely due to a small sample size.

Click to read the study, published today in the Journal of Neurology, Neurosurgery, & Psychiatry

Click to read the accompanying editorial in the Journal of Neurology, Neurosurgery, & Psychiatry

Relevant Reading: CNS demyelinating disorder with mixed features of neuromyelitis optica and multiple sclerosis in HIV-1 infection

In-Depth [retrospective cohort]: This study compared an HIV+ cohort of 21,207 (152,618 person-years) patients and an HIV- cohort of 5,298,496 (39,998,613 person-years) extracted from an English National Health Services hospital record from 1999-2011. All patients had mention of HIV status on their charts and did not initially have MS. The study retrospectively followed the patients and recorded the incidence of MS diagnoses in each population. Expected and observed incidence of MS in the control population were used to calculate the relative risk of MS in the HIV+ cohort. The study found a rate ratio (RR), or ratio of incidences, of 0.38 (CI_95%, 0.15 – 0.79) for the HIV+ group based on 7 observed to 18.3 expected cases. The RR was even lower when analysis was restricted to patients diagnosed with MS 1 year and 5 years after initial HIV diagnosis. Significance of the RR was not appreciated when grouping the cohorts by ethnicity. When taking into account patients who presented with MS at initial admission, the RR was essentially unchanged (0.35; CI_95%, 0.12-0.74). The effect of ART on MS risk was unable to be elucidated in this study.

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