title: Toxoplasmic encephalitis in an AIDS cohort at Puerto Rico before and after highly active antiretroviral therapy (HAART).
abstract: Highly active antiretroviral therapy (HAART) significantly reduced the toxoplasmic encephalitis (TE) incidence in acquired immunodeficiency syndrome (AIDS) patients. The TE incidence and mortality were evaluated in an AIDS cohort followed in Puerto Rico before, during, and after HAART implementation in the Island. Of the 2,431 AIDS studied patients 10.9% had TE diagnosis, with an incidence density that decreased from 5.9/100 person-years to 1.1/100 person-years after HAART. Cox proportional hazard analysis showed substantial mortality reduction among TE cases who received HAART. No mortality reduction was seen in those cases who received TE prophylaxis. Although this study shows a TE incidence and mortality reduction in the AIDS cohort after HAART, the incidence was higher than those reported in the United States AIDS patients. Poor TE prophylaxis compliance might explain the lack of impact of this intervention. Strengthening the diagnostic and opportune TE diagnosis and prompt initiation of HAART in susceptible patients is important to control this opportunistic infection.
authors.affiliation: Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamon, Puerto Rico. amayorb@hotmail.com
authors.forename: Angel M
authors.initials: AM
authors.lastname: Mayor
authors.forename: Diana M
authors.initials: DM
authors.lastname: Fernández Santos
authors.forename: Mark S
authors.initials: MS
authors.lastname: Dworkin
authors.forename: Eddy
authors.initials: E
authors.lastname: Ríos-Olivares
authors.forename: Robert F
authors.initials: RF
authors.lastname: Hunter-Mellado
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011647:Puerto Rico / Q000453:epidemiology; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000401:mortality / Q000517:prevention & control*