Journal Article

Prevalence, Associated Factors, and Prognostic Determinants of AIDS-Related Toxoplasmic Encephalitis in the Era of Advanced Highly Active Antiretroviral Therapy

Andrea Antinori, Dora Larussa, Antonella Cingolani, Patrizia Lorenzini, Simona Bossolasco, Maria Grazia Finazzi, Marco Bongiovanni, Giovanni Guaraldi, Susanna Grisetti, Beniamino Vigo, Beniamino Gigli, Andrea Mariano, Ernesto Renato Dalle Nogare, Michele De Marco, Francesca Moretti, Paola Corsi, Nicola Abrescia, Patrizia Rellecati, Antonella Castagna, Cristina Mussini, Adriana Ammassari, Paola Cinque and Antonella d'Arminio Monforte

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 11, pages 1681-1691
Published in print December 2004 | ISSN: 1058-4838
Published online December 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/424877
Prevalence, Associated Factors, and Prognostic Determinants of AIDS-Related Toxoplasmic Encephalitis in the Era of Advanced Highly Active Antiretroviral Therapy

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Background. Characteristics, associated factors, and survival probability of toxoplasmic encephalitis (TE) in the era of advanced highly active antiretroviral therapy (HAART) have not been fully clarified.

Methods. Data for 205 individuals with acquired immunodeficiency syndrome (AIDS)-related TE were derived from the Italian Registry Investigative NeuroAIDS database, and the cases were studied longitudinally to evaluate prevalence, clinical characteristics, and survival. Moreover, the relationship between the occurrence of TE and exposure to antiretroviral therapy and to TE prophylaxis was evaluated.

Results. With an overall prevalence of 26%, TE represented the most frequent neurological disorder in the cohort. Female sex, severe immunodeficiency, and absence of primary TE prophylaxis significantly increased the risk of TE, and previous exposure to antiretroviral therapy reduced the probability of disease occurrence. Thirty-six percent of patients who had received antiretroviral therapy developed TE, although in most of these cases, the patient experienced failure of antiretroviral therapy. Of note, 66% of patients who had experienced antiretroviral therapy did not receive prophylaxis for TE at TE diagnosis.

The 1-year probability of that infection with human immunodeficiency virus (HIV) would progress or that death would occur after TE was 40% and 23%, respectively. Cognitive symptoms, low CD4+ cell count, not receiving HAART after TE, and initiating HAART >2 months after TE diagnosis were all significantly associated with an increased probability of progression of HIV infection. Not receiving HAART after diagnosis negatively affected survival.

Conclusions. TE remains a highly prevalent disorder of the central nervous system, even in the late HAART era, particularly among severely immunosuppressed patients and in absence of prophylaxis. Considering that persons with TE have a high probability of early death, prophylaxis should be maintained in immunosuppressed patients who experience failure of antiretroviral therapy, and HAART should be initiated as soon as possible after TE diagnosis.

Journal Article.  5438 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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