Skip Navigation LinksHome > March 2013 - Volume 24 - Issue 2 > Treatment of HIV and Risk of Multiple Sclerosis
Epidemiology:
doi: 10.1097/EDE.0b013e318281e48a
Letters

Treatment of HIV and Risk of Multiple Sclerosis

Nexø, Bjørn Andersen; Pedersen, Lars; Sørensen, Henrik Toft; Koch-Henriksen, Nils

Free Access
Article Outline
Collapse Box

Author Information

Department of Biomedicine, Aarhus University, Aarhus, Denmark. nexo@hum-gen.au.dk

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Danish Multiple Sclerosis Registry Copenhagen University Hospital Rigshospitalet Copenhagen, Denmark Department of Neurology Aalborg University Hospital Aalborg, Denmark

Supported by the Lundbeck Foundation and the Danish Multiple Sclerosis Society. N.K.-H. has received honoraria for lecturing and advisory board membership from Novartis, BiogenIdec, and Teva.

Back to Top | Article Outline

To the Editor:

Multiple sclerosis (MS) remains a poorly understood multifactorial disease that is difficult to prevent and treat. Possible etiological factors include retroviruses. Studies of several animal species indicate that retroviruses can cause demyelinating diseases of the central nervous system. Reports suggest that MS is associated with specific retroviruses endogenous to humans.1,2

The possible association between retroviruses and MS raises the question of whether antiretroviral drugs might alleviate or cure MS, if the disease depends on an ongoing infection. Recently, a case report described the clinical course of a man with both MS and HIV.3 Ten years after being diagnosed with MS, he began to take highly active antiretroviral therapy (HAART) for HIV infection. After 3 years, his MS symptoms subsided and have not returned in the subsequent 12 years. To put this question, we investigated the incidence of MS in a cohort of HIV-positive Danes compared with the incidence in the general population. The analysis was facilitated by high-quality medical databases, indexed by the personal identification number assigned to all Danish residents at birth or upon immigration.4 We based the analysis on the Danish National Registry of Patients, which covers all Danish hospitals and is linked to the Civil Registration System and the Danish MS Registry.5

We identified 5018 patients with a first-time HIV diagnosis recorded in the registries between 1994 and 2011 and followed them for a total of 31,875 person-years (median follow-up: 5.2 years). We also followed 50,149 comparison cohort members from the general population, matched on age and sex, for a total of 393,871 person-years (median follow-up: 7.6 years). Follow-up was until the onset of MS, death, or end of the observation period, whichever came first. One HIV-positive patient acquired MS (incidence rate = 3.1 per 100,000 person-years [95% confidence interval (CI) = 0.079–17.47]), as did 41 members of the general population cohort (10.4 per 100,000 person-years [7.7–14.1]). Thus, the incidence rate ratio (IRR) of MS was 0.3 (95% CI = 0.04–2.2) among HIV patients. The Figure shows a plot of the P value testing the compatibility of our data with every possible IRR value.6 Although our results do not reach the conventional level of statistical significance, they suggest a decreased risk of MS among HIV patients.

FIGURE. The P value ...
FIGURE. The P value ...
Image Tools

We also performed a similar analysis on the incidence of rheumatoid arthritis, another disease that includes tissue degeneration and that may involve retroviruses. The IRR was also <1.0, although less pronounced.

These results support the suggestion of the case report that antiretroviral treatment may curb the development of MS. The alternative explanation that HIV patients are underdiagnosed for MS is unlikely because these patients receive close medical attention. It also remains a possibility that HIV itself, rather than HAART, somehow protects against MS, although HAART effectively suppresses HIV expression.

Our results point to the need for a larger study (perhaps an international consortium) to examine the influence of HIV drugs on MS and the possibility of clinical trials.

Bjørn Andersen Nexø

Department of Biomedicine

Aarhus University

Aarhus, Denmark

nexo@hum-gen.au.dk

Lars Pedersen

Henrik Toft Sørensen

Department of Clinical Epidemiology

Aarhus University Hospital

Aarhus, Denmark

Nils Koch-Henriksen

Department of Clinical Epidemiology

Aarhus University Hospital

Aarhus, Denmark

Danish Multiple Sclerosis Registry

Copenhagen University Hospital

Rigshospitalet

Copenhagen, Denmark

Department of Neurology

Aalborg University Hospital

Aalborg, Denmark

Back to Top | Article Outline

REFERENCES

1. Perron H, Garson JA, Bedin F, et al.Molecular identification of a novel retrovirus repeatedly isolated from patients with multiple sclerosis. The Collaborative Research Group on Multiple Sclerosis. Proc Natl Acad Sci U S A. 1997;94:7583–7588

2. Nexø BA, Christensen T, Frederiksen J, et al. The etiology of multiple sclerosis: genetic evidence for the involvement of the human endogenous retrovirus HERV-Fc1. PLoS ONE. 2011;6:e16652

3. Maruszak H, Brew BJ, Giovannoni G, Gold J. Could antiretroviral drugs be effective in multiple sclerosis? A case report. Eur J Neurol. 2011;18:e110–e111

4. Frank LEpidemiology. . When an entire country is a cohort. Science. 2000;287:2398–2399

5. Brønnum-Hansen H, Koch-Henriksen N, Stenager E. The Danish Multiple Sclerosis Registry. Scand J Public Health. 2011;39(7 suppl):62–64

6. Poole C. Beyond the confidence interval. Am J Public Health. 1987;77:195–199

Cited By:

This article has been cited 2 time(s).

Bmc Neurology
Endogenous retroviruses and multiple sclerosis-new pieces to the puzzle
Nissen, KK; Laska, MJ; Hansen, B; Terkelsen, T; Villesen, P; Bahrami, S; Petersen, T; Pedersen, FS; Nexo, BA
Bmc Neurology, 13(): -.
ARTN 111
CrossRef
Plos One
Restriction Genes for Retroviruses Influence the Risk of Multiple Sclerosis
Nexo, BA; Hansen, B; Nissen, KK; Gundestrup, L; Terkelsen, T; Villesen, P; Bahrami, S; Petersen, T; Pedersen, FS; Laska, MJ
Plos One, 8(9): -.
ARTN e74063
CrossRef
Back to Top | Article Outline

© 2013 Lippincott Williams & Wilkins, Inc.

Twitter  Facebook

Login

Article Tools

Images

Share