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NLM AIDSLINE
Toxoplasma gondii infection in advanced HIV infection.
Oksenhendler E; Charreau I; Tournerie C; Azihary M; Carbon C; Aboulker
September 30, 1994
AIDS. 1994 Apr;8(4):483-7. Unique Identifier : AIDSLINE MED/94280720

OBJECTIVE: To study Toxoplasma encephalitis (TE) in advanced HIV infection, including predictive factors, possible prophylactic regimens and impact on survival. DESIGN: Epidemiological analysis of data collected prospectively during the Alpha study, a double-blind, randomized clinical trial, comparing two doses of dideoxyinosine in patients with advanced HIV disease. PATIENTS: First episode of TE occurred in 75 out of 499 patients participating in the trial. METHODS: Kaplan-Meier estimates and semi-parametric Cox's model were used. RESULTS: A low CD4 cell count and a positive Toxoplasma serology were strongly predictive of the occurrence of TE. In patients with CD4 counts < 100 x 10(6)/l and a positive Toxoplasma serology at entry to the study, the 12-month TE incidence was 25.4%. Patients who were receiving at entry any of the following potentially antitoxoplasmic drugs: trimethoprim-sulphamethoxazole, pyrimethamine, dapsone, pyrimethamine-sulphadoxine or sulphadiazine, had a lower TE incidence than those who were not; 6.2 versus 18.8%, respectively (P < 0.001). The rate of survival 12 months after TE was 29.6%. Even after adjusting the major prognostic covariates, TE was predictive of death (P < 0.001; relative risk, 1.8). CONCLUSIONS: The high HIV incidence, morbidity and mortality in high-prevalence areas suggests that primary prophylaxis should be given in patients at high risk for toxoplasmic reactivation.

Adult AIDS-Related Opportunistic Infections/*EPIDEMIOLOGY/MORTALITY/ PREVENTION & CONTROL Dapsone/THERAPEUTIC USE Encephalitis/EPIDEMIOLOGY/MORTALITY/PREVENTION & CONTROL Female Human Male Middle Age Pyrimethamine/THERAPEUTIC USE Sulfadiazine/THERAPEUTIC USE Sulfadoxine/THERAPEUTIC USE Survival Rate Toxoplasmosis/*EPIDEMIOLOGY/MORTALITY/PREVENTION & CONTROL Toxoplasmosis, Cerebral/*EPIDEMIOLOGY/MORTALITY/PREVENTION & CONTROL Trimethoprim-Sulfamethoxazole Combination/THERAPEUTIC USE JOURNAL ARTICLE MULTICENTER STUDY

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