Reasons for failure of prevention of Toxoplasma encephalitis. Swiss HIV Cohort Study.
OBJECTIVE
To study whether absence of prophylaxis is a risk factor for cerebral toxoplasmosis, and to determine the reasons for absence of prophylaxis among AIDS patients diagnosed with Toxoplasma encephalitis (TE).


METHODS
Retrospective chart review and matched case-control study.


METHODS
Patients (104 first episodes and 26 relapses of TE) were registered in the Swiss HIV Cohort Study from three centres from July 1992 to December 1994; 91 matched controls were included for 52 patients with a first episode, and 17 matched controls for 17 patients with relapse of TE.


RESULTS
Prophylaxis was prescribed to 17 patients (16%) with a first episode and 19 patients (73%) with a relapse of TE. Reasons for the absence of prophylaxis included patient refusal (25%), non-proposal by physicians (17%), and drug intolerance (17%). Reduced absorption due to non-compliance, diarrhoea or vomiting was identified among 12 patients with a first episode and 14 patients with a relapse of TE. Absence of prescription of prophylaxis was associated with a 10-fold increased risk of a first episode of TE (odds ratio, 9.8; 95% confidence interval, 2.7-35.4) in the matched case-control study.


CONCLUSIONS
TE continues to occur among patients not receiving prophylaxis. At least one-half of the cases may be prevented with better motivation of physicians and increased compliance of patients.
Van Delden
C
C
Division of Infectious Diseases, University Hospitals of Geneva, Switzerland.
Gabriel
V
V
Sudre
P
P
Flepp
M
M
von Overbeck
J
J
Hirschel
B
B
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004660:Encephalitis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016781:Toxoplasmosis, Cerebral / Q000517:prevention & control*
D000981:Antiprotozoal Agents