Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy.
BACKGROUND
Characteristics, associated factors, and survival probability of toxoplasmic encephalitis (TE) in the era of advanced highly active antiretroviral therapy (HAART) have not been fully clarified.


METHODS
Data for 205 individuals with acquired immunodeficiency syndrome (AIDS)-related TE were derived from the Italian Registry Investigative NeuroAIDS database, and the cases were studied longitudinally to evaluate prevalence, clinical characteristics, and survival. Moreover, the relationship between the occurrence of TE and exposure to antiretroviral therapy and to TE prophylaxis was evaluated.


RESULTS
With an overall prevalence of 26%, TE represented the most frequent neurological disorder in the cohort. Female sex, severe immunodeficiency, and absence of primary TE prophylaxis significantly increased the risk of TE, and previous exposure to antiretroviral therapy reduced the probability of disease occurrence. Thirty-six percent of patients who had received antiretroviral therapy developed TE, although in most of these cases, the patient experienced failure of antiretroviral therapy. Of note, 66% of patients who had experienced antiretroviral therapy did not receive prophylaxis for TE at TE diagnosis. The 1-year probability of that infection with human immunodeficiency virus (HIV) would progress or that death would occur after TE was 40% and 23%, respectively. Cognitive symptoms, low CD4(+) cell count, not receiving HAART after TE, and initiating HAART >2 months after TE diagnosis were all significantly associated with an increased probability of progression of HIV infection. Not receiving HAART after diagnosis negatively affected survival.


CONCLUSIONS
TE remains a highly prevalent disorder of the central nervous system, even in the late HAART era, particularly among severely immunosuppressed patients and in absence of prophylaxis. Considering that persons with TE have a high probability of early death, prophylaxis should be maintained in immunosuppressed patients who experience failure of antiretroviral therapy, and HAART should be initiated as soon as possible after TE diagnosis.
Antinori
Andrea
A
Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. antinori@inmi.it
Larussa
Dora
D
Cingolani
Antonella
A
Lorenzini
Patrizia
P
Bossolasco
Simona
S
Finazzi
Maria Grazia
MG
Bongiovanni
Marco
M
Guaraldi
Giovanni
G
Grisetti
Susanna
S
Vigo
Beniamino
B
Gigli
Beniamino
B
Mariano
Andrea
A
Dalle Nogare
Ernesto Renato
ER
De Marco
Michele
M
Moretti
Francesca
F
Corsi
Paola
P
Abrescia
Nicola
N
Rellecati
Patrizia
P
Castagna
Antonella
A
Mussini
Cristina
C
Ammassari
Adriana
A
Cinque
Paola
P
d'Arminio Monforte
Antonella
A
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004660:Encephalitis / Q000453:epidemiology* / Q000209:etiology / Q000469:parasitology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015996:Survival Rate; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology* / Q000209:etiology