Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era - 01/08/17
, Magnus Glindvad Ahlström b, Madeleine Touma b, Frederik Neess Engsig c, Nina Breinholt Stærke d, Mette Stærkind e, Niels Obel b, Line D. Rasmussen aSummary |
Background |
HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.
Methods |
From the Danish HIV Cohort Study, we identified 6325 HIV-infected individuals. We assessed incidence, mortality, predictive and prognostic factors of CTX during the pre-combination antiretroviral therapy (pre-cART; 1995–1996) and cART-era (1997–2014). Adjusted incidence rate ratios (aIRR), mortality rate ratios (aMRR) and 95% confidence intervals (CI) were assessed using Poisson regression analysis.
Results |
CTX IR was 1.17/1000 PYR (95% CI 0.93–1.47). We observed no change in CTX-risk in the first year after HIV-diagnosis, but a substantial reduction in mortality in the first 3 months after CTX diagnosis when comparing the cART-era to the pre-cART-era; {(aIRR: 0.79; 95% CI: 0.37–1.72) (aMRR: 0.15; 95% CI: 0.06–0.38)}. For individuals surviving the first year after HIV-diagnosis or the first 3 months after CTX-diagnosis, IRR and MRR had declined to minimal levels {(aIRR: 0.06; 95% CI: 0.03–0.10); (aMRR: 0.02; 95% CI: 0.01–0.05)}. Three years after CTX-diagnosis 30% of the patients still had neurological deficits.
Conclusion |
Although, CTX remains an important cause of morbidity and mortality in the cART-era, with high prevalence of neurological sequelae, incidence and mortality has largely declined, especially among those surviving the first year after diagnosis.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Data from the Danish HIV Cohort Study – a nationwide population-based cohort study. |
• | Declining incidence of CTX in the cART-era after surviving the 1st year. |
• | Declining CTX mortality in the cART-era, specially after surviving the first 3 months. |
• | CTX remains an important cause of morbidity and mortality in late presenters. |
• | CTX has an important impact in the patient's later well being and quality of life. |
Keywords : Cerebral toxoplasmosis, Combination antiretroviral therapy, HIV, Opportunistic infections
Plan
Vol 75 - N° 3
P. 263-273 - septembre 2017 Retour au numéro
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