Early Antiretroviral Therapy in AIDS Patients Presenting With Toxoplasma gondii Encephalitis Is Associated With More Sequelae but Not Increased Mortality

Frontiers in Medicine

article

Nadia Cubas-Vega¹  Paola López Del-Tejo¹  Djane C. Baia-da-Silva¹  Vanderson Souza Sampaio¹  Bruno Araújo Jardim²  Monique Freire Santana¹  Luiz Carlos Lima Ferreira¹  Izabella Picinin Safe¹  Márcia A. Araújo Alexandre⁷  Marcus Vinícius Guimarães Lacerda¹  Wuelton Marcelo Monteiro¹  Fernando Val¹ 

[1] Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas;Instituto de Pesquisa Clínica Carlos Borborema;Instituto Leônidas and Maria Deane;Gerência de Endemias;Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas;Departameto de Patologia e Medicina Legal, Universidade Federal do Amazonas;Departamento Clínico

关键词: Toxoplasma gondii;    toxoplasmic encephalitis;    HIV/AIDS;    therapy;    antiretroviral;    complications;   

DOI  :  10.3389/fmed.2022.759091

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Evidence on the optimal time to initiate antiretroviral therapy (ART) in the presence of toxoplasmic encephalitis (TE) is scarce. We compared the impact of early vs. delayed ART initiation on mortality and neurologic complications at discharge in a Brazilian population co-infected with HIV and TE. Methods We retrospectively evaluated data from 9 years of hospitalizations at a referral center in Manaus, Amazonas. All ART-naïve hospitalized patients were divided into early initiation treatment (EIT) (0-4 weeks) and delayed initiation treatment (DIT) (>4 weeks). The groups were compared using chi-square test and mortality at 16 weeks. Results Four hundred sixty nine patients were included, of whom 357 (76.1%) belonged to the EIT group. The median CD4 + lymphocyte count and CD4 + /CD8 + ratio were 53 cells/mm 3 and 0.09, respectively. Mortality rate and presence of sequelae were 4.9% ( n = 23) and 41.6% ( n = 195), respectively. Mortality was similar between groups ( p = 0.18), although the EIT group had the highest prevalence of sequelae at discharge ( p = 0.04). The hazard ratio for death at 16 weeks with DIT was 2.3 ( p = 0.18). The necessity for intensive care unit admission, mechanical ventilation, and cardiopulmonary resuscitation were similar between groups. Conclusion In patients with AIDS and TE, early ART initiation might have a detrimental influence on the occurrence of sequelae.

【 授权许可】

CC BY