title: Toxoplasmic encephalitis in AIDS-patients before and after the introduction of highly active antiretroviral therapy (HAART).
abstract: Toxoplasmic encephalitis (TE) continues to be a severe health problem despite the introduction of highly active antiretroviral therapy (HAART). To identify predictors for development of TE we compared demographic, clinical and diagnostic variables in AIDS patients with TE before (n = 102) or after the introduction (n = 70) of HAART at the Charité University Medicine in Berlin, Germany. Interestingly, patient characteristics did not differ significantly in the pre- and post-HAART groups. Sixty-eight percent of patients had CD4-cell counts of <50/μl. Outcome after treatment with pyrimethamin plus sulfonamides or clindamycin (47% each) did not differ; adverse reactions were more frequent in patients receiving sulfonamides than in those receiving clindamycin (25% vs. 10.5%; p = 0.02). Interestingly, patients in the post HAART group had not received (82.9%) or had not taken HAART adequately (17.1%). Concurrent diagnosis of TE and HIV was significantly more often in the post- compared to the pre-HAART group (49 vs. 26%, respectively; p > 0.001). Thus, despite the introduction of HAART, awareness of opportunistic infections in HIV patients is warranted. High rates of unawareness of HIV infection should make public health efforts focus on early identification of HIV infection and initiation of and compliance with HAART.
authors.affiliation: Institute for Microbiology and Hygiene, Campus Benjamin Franklin, Charité Medical School Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: T R
authors.initials: TR
authors.lastname: Kiderlen
authors.forename: O
authors.initials: O
authors.lastname: Liesenfeld
authors.forename: D
authors.initials: D
authors.lastname: Schürmann
authors.forename: T
authors.initials: T
authors.lastname: Schneider
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D001604:Berlin / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002981:Clindamycin / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000008:administration & dosage; D012307:Risk Factors; D013449:Sulfonamides / Q000008:administration & dosage; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents; D013449:Sulfonamides; D002981:Clindamycin; D011739:Pyrimethamine