Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era

Raquel Martin-Iguacel; Magnus Glindvad Ahlström; Madeleine Touma; Frederik Neess Engsig; Nina Breinholt Stærke; Mette Stærkind; Niels Obel; Line D. Rasmussen

doi:10.1016/j.jinf.2017.05.018

Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era

Raquel Martin-Iguacel^*, Magnus Glindvad Ahlström, Madeleine Touma, Frederik Neess Engsig, Nina Breinholt Stærke, Mette Stærkind, Niels Obel, Line D. Rasmussen

^*Corresponding author for this work

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Journal of Infection
Volume	75
Issue number	3
Pages (from-to)	263-273
Number of pages	11
ISSN	0163-4453
DOIs	https://doi.org/10.1016/j.jinf.2017.05.018
Publication status	Published - Sept 2017

Keywords

Cerebral toxoplasmosis
Combination antiretroviral therapy
HIV
Opportunistic infections

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jinf.2017.05.018

Cite this

@article{1861c1b3052540318254c1fa22d43145,

title = "Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era",

abstract = "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.",

keywords = "Cerebral toxoplasmosis, Combination antiretroviral therapy, HIV, Opportunistic infections",

author = "Raquel Martin-Iguacel and Ahlstr{\"o}m, {Magnus Glindvad} and Madeleine Touma and Engsig, {Frederik Neess} and St{\ae}rke, {Nina Breinholt} and Mette St{\ae}rkind and Niels Obel and Rasmussen, {Line D.}",

year = "2017",

month = sep,

doi = "10.1016/j.jinf.2017.05.018",

language = "English",

volume = "75",

pages = "263--273",

journal = "Journal of Infection",

issn = "0163-4453",

publisher = "W.B.Saunders Co. Ltd.",

number = "3",

}

TY - JOUR

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

SN - 0163-4453

VL - 75

SP - 263

EP - 273

JO - Journal of Infection

JF - Journal of Infection

IS - 3