Immune reconstitution inflammatory syndrome associated with toxoplasmic encephalitis in HIV-infected patients
| Autor: | Ward P H van Bilsen, L. B. S. Gelinck, Charlotte H S B van den Berg, Bart J. A. Rijnders, Kees Brinkman, Jan Mulder, Jan M. Prins, Andy I. M. Hoepelman, Diederik van de Beek, Ferdinand W. N. M. Wit |
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| Přispěvatelé: | AII - Infectious diseases, APH - Global Health, Graduate School, APH - Aging & Later Life, Other departments, Neurology, AII - Amsterdam institute for Infection and Immunity, Infectious diseases, General Internal Medicine, Internal Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
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Adult Male medicine.medical_specialty Anti-HIV Agents Immunology HIV Infections urologic and male genital diseases Cohort Studies 03 medical and health sciences 0302 clinical medicine Immune reconstitution inflammatory syndrome SDG 3 - Good Health and Well-being Immune Reconstitution Inflammatory Syndrome Internal medicine Immunology and Allergy Medicine Humans 030212 general & internal medicine cardiovascular diseases Subclinical infection Netherlands business.industry urogenital system Incidence (epidemiology) Incidence fungi Middle Aged Viral Load medicine.disease Toxoplasmosis female genital diseases and pregnancy complications CD4 Lymphocyte Count Infectious Diseases Toxoplasmosis Cerebral Cohort Encephalitis Female business Viral load 030217 neurology & neurosurgery Cohort study |
| Zdroj: | AIDS (London, England), 31(10), 1415-1424. Lippincott Williams and Wilkins AIDS, 31(10), 1415-1424. Lippincott Williams & Wilkins |
| ISSN: | 0269-9370 |
| Popis: | To investigate the incidence and risk factors of immune reconstitution inflammatory syndrome (IRIS) associated with toxoplasmic encephalitis (TE) in patients starting combination antiretroviral therapy (cART). A historical multicenter cohort study. We included all HIV-infected patients diagnosed with toxoplasmic encephalitis in six Dutch hospitals between 1996 and 2016. Diagnosis of TE-IRIS was made using predefined IRIS criteria. We distinguished paradoxical TE-IRIS (worsening of underlying treated infection) from unmasking TE-IRIS (unmasking of subclinical infection after start of cART). We compared CD4 cell count, plasma viral load and timing of cART initiation between patients with and without paradoxical TE-IRIS. A total of 211 toxoplasmic encephalitis cases were included. Among 143 cases at risk for paradoxical TE-IRIS, we identified five cases of paradoxical TE-IRIS (3.5%). In six other cases, we could not differentiate paradoxical TE-IRIS from recurrence of disease due to inadequate secondary Toxoplasma prophylaxis. There was no difference in time between start of toxoplasmic encephalitis treatment and cART initiation for patients who did or did not develop paradoxical TE-IRIS (P = 0.50). Within the group of 2228 patients who started cART while having a CD4 cell count below 200 × 10 cells/l and receiving adequate primary prophylaxis, we identified eight cases of unmasking TE-IRIS (0.36%). Unmasking TE-IRIS could not be differentiated from a newly occurring toxoplasmic encephalitis in six other patients, as they were not receiving adequate primary prophylaxis against Toxoplasma. Unmasking TE-IRIS was rare in this cohort, whereas paradoxical TE-IRIS did occur more often. We found no relationship between the timing of cART initiation and the occurrence of paradoxical TE-IRIS |
| Databáze: | OpenAIRE |
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