Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients
Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients
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DOI：
10.1097/00002030-199611000-00010
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发表时间：
1996-11-01
期刊：
影响因子：
3.8
通讯作者：
Salamon, R
中科院分区：
文献类型：
--
作者：
Derouin, F;Leport, C;Salamon, R
目的：探讨弓形虫抗体滴度对人类免疫缺陷病毒(HIV)感染者弓形虫脑炎(TE)发生的预测价值。方法：对一项弓形虫脑炎一级预防试验(ANRS 005/ACTG 154)的安慰剂组数据进行分析。患者包括CD_4+细胞计数和200x10(6)/L，弓形虫血清学阳性。在同一实验室采用酶联免疫吸附试验和血清凝集试验对入境时弓形虫抗体滴度进行回顾性测定。用Kaplan-Meier法估计TE的发病率，用Cox模型研究抗体滴度在校正其他协变量后的预测价值。结果：164例患者均为IgE抗体阳性，1例为IgM抗体阳性。经过平均16个月的随访，记录了31例TE病例。Ige滴度大于或等于150Lu/ml的患者的一年内TE发生率(23.7%)显著高于滴度为150Lu/ml的患者(7.7%；相对危险度3.1；P<；0.003)。在COX模型中，Ig G滴度仍然与TE的发生显著相关(相对风险，3.33；P<；0.005)。结论：在CD_4~+细胞计数<200×10~(6)/L的患者中，LGE抗弓形虫抗体滴度是TE发生的一个预后因素，滴度大于或等于150IU/ml的患者发生TE的风险较高。这一发现应加强对这些患者进行特异性预防的建议。
Objective: To study the predictive value of anti-Toxoplasma gondii antibody titres for the occurrence of toxoplasmic encephalitis (TE) in HIV-infected patients.Methods: Data from the placebo arm of a trial of primary prophylaxis for TE (ANRS 005/ACTG 154) were analysed. Patients included had CD4+ cell counts < 200x10(6)/l and a positive Toxoplasma serology. Immunoglobulin (Ig) G and IgM Toxoplasma antibody titres at entry were retrospectively determined by enzyme-linked immunosorbent assay and agglutination on serum samples in a single laboratory. Incidence of TE was estimated by Kaplan-Meier method and a Cox model was used to study the predictive value of antibody titres, adjusted for other covariates.Results: All 164 patients studied were positive for Ige antibodies and one had IgM antibodies. After a mean follow-up of 16 months, 31 cases of TE were documented. One-year incidence of TE was significantly higher in patients with Ige titres greater than or equal to 150 lU/ml (23.7%) than in patients with titres < 150 lU/ml (7.7%; relative risk, 3.1; P < 0.003). IgG titres remained significantly associated with the occurrence of TE (relative risk, 3.3; P < 0.005) in the Cox model. Predictive value of [ge titres did not differ according to baseline CD4+ cell counts.Conclusion: In patients with CD4+ cell counts < 200x10(6)/l, lge anti-Toxoplasma antibody titre is a prognostic factor of occurrence of TE, with a higher risk for titres greater than or equal to 150 IU/ml. This finding should reinforce the recommendation of specific prophylaxis in these patients.