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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Vydáno v:The Journal of infection Ročník 75; číslo 3; s. 263 - 273
Hlavní autoři: Martin-Iguacel, Raquel, Ahlström, Magnus Glindvad, Touma, Madeleine, Engsig, Frederik Neess, Stærke, Nina Breinholt, Stærkind, Mette, Obel, Niels, Rasmussen, Line D.
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Elsevier Ltd 01.09.2017
Témata:
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
Opportunistic infections
Combination antiretroviral therapy
HIV
Cerebral toxoplasmosis
ISSN:0163-4453, 1532-2742, 1532-2742
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Shrnutí: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.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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content type line 23
ISSN:0163-4453
1532-2742
1532-2742
DOI:10.1016/j.jinf.2017.05.018