title: Incidence and risk factors for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active antiretroviral therapy era.
abstract: The occurrence of toxoplasmic encephalitis (TE) was studied among 19,598 and 17,016 patients enrolled in the French Hospital Database on human immunodeficiency virus whose CD4 cell counts decreased to < or =200x10(6) cells/L before (1992-1995) or after (1996-1998) the availability of highly active antiretroviral therapy, respectively. The incidence of TE decreased from 3.9 cases per 100 person-years in the first period (95% confidence interval [CI], 3.7-4.1) to 1.0 cases per 100 person-years in the second period (95% CI, 0.9-1.1). After adjustment for known risk factors for TE, patients who received cotrimoxazole prophylaxis had a lower risk of TE (adjusted relative hazard, 0.6 and 0.5, respectively, for the first and second periods; P < .001). For patients treated with cotrimoxazole at inclusion, discontinuation of cotrimoxazole increased the risk of TE in both periods (adjusted relative hazard, 4.8 and 4.2, respectively; P < .001). Among patients whose CD4 cell counts increased to > 200 x 10(6) cells/L while undergoing highly active antiretroviral therapy, the incidence of TE was 0.1 cases per 100 person-years (95% CI, 0.0-0.2) and was not increased by discontinuation of cotrimoxazole.
authors.affiliation: Service Commun numéro 4 de l'Institut National de la Santé et de la Recherche Médicale, Paris, France. abgrall@b3e.jussieu.fr
authors.forename: S
authors.initials: S
authors.lastname: Abgrall
authors.forename: C
authors.initials: C
authors.lastname: Rabaud
authors.forename: D
authors.initials: D
authors.lastname: Costagliola
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000469:parasitology; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology* / Q000469:parasitology
chemical_list: D011480:Protease Inhibitors