Discontinuation of maintenance therapy against toxoplasma encephalitis in AIDS patients with sustained response to anti-retroviral therapy

Autor: Hansjakob Furrer, Veronique Schiffer, Markus Flepp, J. P. Chave, Milos Opravil, Anna Christen, Matthias Cavassini, Patrick Schmid, S. Bertschy, Enos Bernasconi
Rok vydání: 2006
Předmět:
Male
encephalitis
CD4 cell count
0302 clinical medicine
Maintenance therapy
Recurrence
030212 general & internal medicine
Prospective Studies
Sida
Prospective cohort study
0303 health sciences
biology
human immunodeficiency virus
General Medicine
Middle Aged
Viral Load
Magnetic Resonance Imaging
3. Good health
AIDS
Treatment Outcome
Infectious Diseases
Anti-Retroviral Agents
Toxoplasmosis
Cerebral
Female
medicine.symptom
Encephalitis
Switzerland
Cohort study
toxoplasmosis
Adult
Microbiology (medical)
medicine.medical_specialty
Antiprotozoal Agents
Asymptomatic
03 medical and health sciences
Acquired immunodeficiency syndrome (AIDS)
Internal medicine
medicine
Animals
Humans
Acquired Immunodeficiency Syndrome
AIDS-Related Opportunistic Infections
030306 microbiology
business.industry
discontinuation of therapy
medicine.disease
biology.organism_classification
Discontinuation
CD4 Lymphocyte Count
Immunology
business
Zdroj: Clinical Microbiology and Infection. 12(7):666-671
ISSN: 1198-743X
DOI: 10.1111/j.1469-0691.2006.01459.x
Popis: Discontinuation of maintenance therapy against toxoplasma encephalitis (TE) for individuals infected with human immunodeficiency virus (HIV) who are receiving successful anti-retroviral therapy is considered safe. Nevertheless, there are few published studies concerning this issue. Within the setting of the Swiss HIV Cohort Study, this report describes a prospective study of discontinuation of maintenance therapy against TE in patients with a sustained increase of CD4 counts to > 200 cells/μL and 14% of total lymphocytes, and no active lesions on cerebral magnetic resonance imaging (MRI). In addition to clinical evaluation, cerebral MRI was performed at baseline, and 1 and 6 months following discontinuation. Twenty-six AIDS patients with a history of TE agreed to participate, but three patients (11%) could not be enrolled because they still showed enhancing cerebral lesions without a clinical correlate. One patient refused MRI after 6 months while clinically asymptomatic. Among the remaining 22 patients who discontinued maintenance therapy, one relapsed after 3 months. During a total follow-up of 58 patient-years, there was no TE relapse among the patients who had remained clinically and radiologically free of relapse during the study. Thus, discontinuation of maintenance therapy against TE was generally safe, but may fail in a minority of patients. Patients who remain clinically and radiologically free of relapse at 6 months after discontinuation are unlikely to experience a relapse of TE.
Databáze: OpenAIRE
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