Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era
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Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era. / Martin-Iguacel, Raquel; Ahlström, Magnus Glindvad; Touma, Madeleine; Engsig, Frederik Neess; Stærke, Nina Breinholt; Stærkind, Mette; Obel, Niels; Rasmussen, Line D.
I: Journal of Infection, Bind 75, Nr. 3, 09.2017, s. 263-273.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era
AU - Martin-Iguacel, Raquel
AU - Ahlström, Magnus Glindvad
AU - Touma, Madeleine
AU - Engsig, Frederik Neess
AU - Stærke, Nina Breinholt
AU - Stærkind, Mette
AU - Obel, Niels
AU - Rasmussen, Line D.
PY - 2017/9
Y1 - 2017/9
N2 - Background HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. Methods From the Danish HIV Cohort Study, we identified 6325 HIV-infected individuals. We assessed incidence, mortality, predictive and prognostic factors of CTX during the pre-combination antiretroviral therapy (pre-cART; 1995–1996) and cART-era (1997–2014). Adjusted incidence rate ratios (aIRR), mortality rate ratios (aMRR) and 95% confidence intervals (CI) were assessed using Poisson regression analysis. Results CTX IR was 1.17/1000 PYR (95% CI 0.93–1.47). We observed no change in CTX-risk in the first year after HIV-diagnosis, but a substantial reduction in mortality in the first 3 months after CTX diagnosis when comparing the cART-era to the pre-cART-era; {(aIRR: 0.79; 95% CI: 0.37–1.72) (aMRR: 0.15; 95% CI: 0.06–0.38)}. For individuals surviving the first year after HIV-diagnosis or the first 3 months after CTX-diagnosis, IRR and MRR had declined to minimal levels {(aIRR: 0.06; 95% CI: 0.03–0.10); (aMRR: 0.02; 95% CI: 0.01–0.05)}. Three years after CTX-diagnosis 30% of the patients still had neurological deficits. Conclusion Although, CTX remains an important cause of morbidity and mortality in the cART-era, with high prevalence of neurological sequelae, incidence and mortality has largely declined, especially among those surviving the first year after diagnosis.
AB - Background HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years. Methods From the Danish HIV Cohort Study, we identified 6325 HIV-infected individuals. We assessed incidence, mortality, predictive and prognostic factors of CTX during the pre-combination antiretroviral therapy (pre-cART; 1995–1996) and cART-era (1997–2014). Adjusted incidence rate ratios (aIRR), mortality rate ratios (aMRR) and 95% confidence intervals (CI) were assessed using Poisson regression analysis. Results CTX IR was 1.17/1000 PYR (95% CI 0.93–1.47). We observed no change in CTX-risk in the first year after HIV-diagnosis, but a substantial reduction in mortality in the first 3 months after CTX diagnosis when comparing the cART-era to the pre-cART-era; {(aIRR: 0.79; 95% CI: 0.37–1.72) (aMRR: 0.15; 95% CI: 0.06–0.38)}. For individuals surviving the first year after HIV-diagnosis or the first 3 months after CTX-diagnosis, IRR and MRR had declined to minimal levels {(aIRR: 0.06; 95% CI: 0.03–0.10); (aMRR: 0.02; 95% CI: 0.01–0.05)}. Three years after CTX-diagnosis 30% of the patients still had neurological deficits. Conclusion Although, CTX remains an important cause of morbidity and mortality in the cART-era, with high prevalence of neurological sequelae, incidence and mortality has largely declined, especially among those surviving the first year after diagnosis.
KW - Cerebral toxoplasmosis
KW - Combination antiretroviral therapy
KW - HIV
KW - Opportunistic infections
U2 - 10.1016/j.jinf.2017.05.018
DO - 10.1016/j.jinf.2017.05.018
M3 - Journal article
C2 - 28579301
AN - SCOPUS:85020437568
VL - 75
SP - 263
EP - 273
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
IS - 3
ER -
ID: 188115768