Toxoplasmic Encephalitis in an AIDS Cohort at Puerto Rico before and after Highly Active Antiretroviral Therapy (HAART)
Toxoplasmic Encephalitis in an AIDS Cohort at Puerto Rico before and after Highly Active Antiretroviral Therapy (HAART)
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DOI：
10.4269/ajtmh.2011.10-0718
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发表时间：
2011-05-01
影响因子：
3.3
通讯作者：
Hunter-Mellado, Robert F.
中科院分区：
文献类型：
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作者：
Mayor, Angel M.;Santos, Diana M. Fernandez;Hunter-Mellado, Robert F.
高效抗逆转录病毒治疗（HAART）可显著降低获得性免疫缺陷综合征（AIDS）患者弓形虫脑炎（TE）的发病率。在波多黎各的艾滋病队列中，在岛上实施HAART之前、期间和之后，对TE的发病率和死亡率进行了评价。在2，431名研究的艾滋病患者中，10.9%有TE诊断，HAART后发病密度从5.9/100人-年降至1.1/100人-年。考克斯比例风险分析显示接受HAART的TE病例死亡率显著降低。在接受TE预防的病例中未观察到死亡率降低。虽然这项研究显示，艾滋病队列在HAART治疗后TE发病率和死亡率降低，但发病率高于美国艾滋病患者的报告。TE预防依从性差可能解释了这种干预缺乏影响。加强诊断和及时TE诊断，并在易感患者中及时启动HAART，对控制这种机会性感染非常重要。
Highly active antiretroviral therapy (HAART) significantly reduced the toxoplasmic encephalitis (TE) incidence in acquired immunodeficiency syndrome (AIDS) patients. The TE incidence and mortality were evaluated in an AIDS cohort followed in Puerto Rico before, during, and after HAART implementation in the Island. Of the 2,431 AIDS studied patients 10.9% had TE diagnosis, with an incidence density that decreased from 5.9/100 person-years to 1.1/100 person-years after HAART. Cox proportional hazard analysis showed substantial mortality reduction among TE cases who received HAART. No mortality reduction was seen in those cases who received TE prophylaxis. Although this study shows a TE incidence and mortality reduction in the AIDS cohort after HAART, the incidence was higher than those reported in the United States AIDS patients. Poor TE prophylaxis compliance might explain the lack of impact of this intervention. Strengthening the diagnostic and opportune TE diagnosis and prompt initiation of HAART in susceptible patients is important to control this opportunistic infection.