[Epidemiologic characteristics of cerebral toxoplasmosis in 399 HIV-infected patients followed between 1983 and 1994].
OBJECTIVE
To describe the epidemiological characteristics of toxoplasmic encephalitis in HIV-infected patients with a more than 12-year follow-up.


METHODS
From a data base of 1,628 AIDS subjects hospitalized from 1983 to 1994, we studied the epidemiological characteristics of 399 patients with toxoplasmic encephalitis. Diagnosis of toxoplasmic encephalitis was based on the association of central neurological disorders, typical lesions on CT scan or MRI, and favorable outcome under appropriate toxoplasmosis therapy.


RESULTS
Four hundred sixty-four cases of toxoplasmic encephalitis were reported in 399 patients (24.5% of the patients with AIDS). The overall incidence was 20.5 per 100 patients-year. Toxoplasmic encephalitis was the first AIDS defining event in 51% of the cases and revealed HIV infection in 13% of the cases. In the remaining 49%, the mean delay from AIDS diagnosis to toxoplasmic encephalitis was 13 months (range: 1-71 months). At the time of diagnosis, mean CD4 count was 44/mm3 (range: 0-408/mm3). Antibodies to Toxoplasma gondii were found in 97% of the cases. Before the first episode of toxoplasmic encephalitis, 58% of the patients were given antiretroviral therapy (mean: 17.8 months; range: 1-64 months). Of the 399 patients with toxoplasmic encephalitis, 366 (92%) did not receive any primary toxoplasmosis prophylaxis. Among them, 205 (56%) did not receive any drug prophylaxis, and 161 (44%) had Pneumocystis carinii pneumonia prophylaxis alone (aerosolized pentamidine). Thirty-three failures were observed (8%) with cotrimoxazole: 14 cases (3%) were considered to have irregular compliance. Sixty-five relapses were observed in 52 patients. At the end of the study 334 patients had died (84%). The median survival was 11.4 months (95% confidence interval, range: 10.4-12.4 months).


CONCLUSIONS
Toxoplasmic encephalitis incidence has decreased since the introduction of appropriate drug prophylaxis.
Service de maladies infectieuses et tropicales, Hôpital de la Pitié-Salpêtrière, Paris, France.
P
P
Bossi
E
E
Caumes
P
P
Astagneau
T S
TS
Li
L
L
Paris
X
X
Mengual
C
C
Katlama
F
F
Bricaire
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000032:analysis; D000935:Antifungal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018890:Chemoprevention; D003049:Coccidiostats / Q000627:therapeutic use; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D010419:Pentamidine / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014122:Toxoplasma / Q000276:immunology; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D017211:Treatment Failure; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000913:Antibodies, Protozoan; D000935:Antifungal Agents; D000998:Antiviral Agents; D003049:Coccidiostats; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Caractéristiques épidémiologiques des toxoplasmoses cérébrales chez 399 patients infectés par le VIH suivis entre 1983 et 1994.