Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era
HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. 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 anti...
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| Veröffentlicht in: | The Journal of infection Jg. 75; H. 3; S. 263 - 273 |
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| Abstract | HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.
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.
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.
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.
•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. |
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| AbstractList | Summary 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. HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. 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. 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. 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. •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. HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. 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. 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. 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. HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.BACKGROUNDHIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.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.METHODSFrom 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.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.RESULTSCTX 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.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.CONCLUSIONAlthough, 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. |
| Author | Ahlström, Magnus Glindvad Martin-Iguacel, Raquel Touma, Madeleine Stærke, Nina Breinholt Rasmussen, Line D. Stærkind, Mette Obel, Niels Engsig, Frederik Neess |
| Author_xml | – sequence: 1 givenname: Raquel surname: Martin-Iguacel fullname: Martin-Iguacel, Raquel email: raquel@bisaurin.org organization: Department of Infectious Diseases, Odense University Hospital, Søndre Boulevard 29, 5000 Odense C, Denmark – sequence: 2 givenname: Magnus Glindvad surname: Ahlström fullname: Ahlström, Magnus Glindvad organization: Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark – sequence: 3 givenname: Madeleine surname: Touma fullname: Touma, Madeleine organization: Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark – sequence: 4 givenname: Frederik Neess surname: Engsig fullname: Engsig, Frederik Neess organization: Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark – sequence: 5 givenname: Nina Breinholt surname: Stærke fullname: Stærke, Nina Breinholt organization: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark – sequence: 6 givenname: Mette surname: Stærkind fullname: Stærkind, Mette organization: Department of Infectious Diseases, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark – sequence: 7 givenname: Niels surname: Obel fullname: Obel, Niels organization: Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark – sequence: 8 givenname: Line D. surname: Rasmussen fullname: Rasmussen, Line D. organization: Department of Infectious Diseases, Odense University Hospital, Søndre Boulevard 29, 5000 Odense C, Denmark |
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| Keywords | Opportunistic infections Combination antiretroviral therapy HIV Cerebral toxoplasmosis |
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| Snippet | HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.
From the Danish HIV Cohort Study, we... Summary Background HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. Methods From the Danish... HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.BACKGROUNDHIV-associated incidence and... |
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| SubjectTerms | Adult AIDS-Related Opportunistic Infections - diagnosis AIDS-Related Opportunistic Infections - epidemiology AIDS-Related Opportunistic Infections - mortality AIDS-Related Opportunistic Infections - parasitology Anti-HIV Agents - adverse effects Anti-HIV Agents - therapeutic use Antiretroviral Therapy, Highly Active Cerebral toxoplasmosis Cohort Studies Combination antiretroviral therapy Denmark - epidemiology Drug Therapy, Combination Female HIV HIV Infections - complications HIV Infections - drug therapy Humans Incidence Infectious Disease Male Middle Aged Opportunistic infections Poisson Distribution Prognosis Risk Factors Toxoplasmosis, Cerebral - diagnosis Toxoplasmosis, Cerebral - epidemiology Toxoplasmosis, Cerebral - mortality Toxoplasmosis, Cerebral - parasitology |
| Title | Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era |
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