Incidence, immunological and clinical characteristics of reactivation of latent Toxoplasma gondii infection in HIV-infected patients.
To determine changes in incidence of reactivation of Toxoplasma gondii infection, manifesting as toxoplasmic encephalitis, and to assess the immunological mechanisms controlling reactivation in HIV-infected patients, a Czech cohort of 502 HIV/T. gondii co-infected patients was followed for 2909·3 person-years. The incidence of toxoplasmic encephalitis between the periods before and after the introduction of combination antiretroviral therapy (cART) was compared. Toxoplasmic encephalitis was diagnosed in 21 patients. In those patients the geometric mean value of CD4+ T lymphocytes was 12·6 times lower than in patients with non-reactivated T. gondii infection but an additionally significant decline in CD8+ T lymphocytes (3·3-fold) and natural killer cells (4·3-fold) was observed. This confirms the significance of these parameters. A twelvefold decrease in Toxoplasma reactivation incidence (40·2 vs. 3·4/1000 person-years) between monitored periods was seen. In the cART era, Toxoplasma reactivation was observed only in patients with unrecognized HIV infection or refusing therapy.
National Reference Laboratory for Toxoplasmosis,National Institute of Public Health in Prague, Czech Republic.
P
P
Kodym
Department of Biostatistics and Informatics,National Institute of Public Health in Prague,Czech Republic.
M
M
Malý
Department of Infectious and Tropical Diseases, First Faculty of Medicine,Charles University and Hospital Na Bulovce in Prague,Czech Republic.
O
O
Beran
Department of Infectious and Tropical Diseases, First Faculty of Medicine,Charles University and Hospital Na Bulovce in Prague,Czech Republic.
D
D
Jilich
Department of Infectious and Tropical Diseases, First Faculty of Medicine,Charles University and Hospital Na Bulovce in Prague,Czech Republic.
H
H
Rozsypal
Department of Infectious Diseases, Third Faculty of Medicine,Charles University and Hospital Na Bulovce in Prague,Czech Republic.
L
L
Machala
Department of Infectious and Tropical Diseases, First Faculty of Medicine,Charles University and Hospital Na Bulovce in Prague,Czech Republic.
M
M
Holub
D000328:Adult; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D018153:Czech Republic; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D015994:Incidence; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D008875:Middle Aged; D014122:Toxoplasma / Q000302:isolation & purification*; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology* / Q000473:pathology*
Encephalitis; HIV/AIDS; Toxoplasma gondii; immunology; incidence