title: Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy.
abstract: 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.
authors.affiliation: Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. antinori@inmi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Dora
authors.initials: D
authors.lastname: Larussa
authors.forename: Antonella
authors.initials: A
authors.lastname: Cingolani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Lorenzini
authors.forename: Simona
authors.initials: S
authors.lastname: Bossolasco
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Finazzi
authors.forename: Marco
authors.initials: M
authors.lastname: Bongiovanni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Susanna
authors.initials: S
authors.lastname: Grisetti
authors.forename: Beniamino
authors.initials: B
authors.lastname: Vigo
authors.forename: Beniamino
authors.initials: B
authors.lastname: Gigli
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariano
authors.forename: Ernesto Renato
authors.initials: ER
authors.lastname: Dalle Nogare
authors.forename: Michele
authors.initials: M
authors.lastname: De Marco
authors.forename: Francesca
authors.initials: F
authors.lastname: Moretti
authors.forename: Paola
authors.initials: P
authors.lastname: Corsi
authors.forename: Nicola
authors.initials: N
authors.lastname: Abrescia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Rellecati
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
authors.forename: Paola
authors.initials: P
authors.lastname: Cinque
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
mesh_terms: 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