Toxoplasmic Encephalitis in HIVPositive Patients in Brazil: Clinical features and predictors of trea

1
Toxoplasmic Encephalitisin HIV-Positive Patients
in Brazil Clinical features and predictors
of treatment response in the HAART era

• José E. Vidal, Adrián Hernández, Augusto C.
  Penalva de Oliveira, Rafi F. Dauar, Silas Pereira
  Barbosa Jr, Roberto Focaccia
• Neurosciences Study Group of the
• Emílio Ribas Institute of Infectious Diseases,
  Sao Paulo, Brazil

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Impact of HAART in Brazil

• ? First developing country to have implemented a
  national HAART program
• ? 150,000 Brazilians receive HAART
• ? Survival rate has increased substantially
• ? Opportunistic infections also has declined
  
  
• Marins et al. AIDS 2003171675-82
• Editorial. Lancet
  20053651664
• Brazilian Ministry of Health, 2005

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NeuroAIDS in the HAART era in Brazil (january
2003 january 2004)(n 219)
Institute of Infectious Diseases Emílio Ribas,
Sao Paulo, 2005
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Objectives

• 1. To describe the main features of Brazilian
  AIDS patients with TE in the late HAART era
• 2. To identify predictive factors of partial
  clinical response to anti - Toxoplasma treatment

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Methods

• Design prospective longitudinal study (June 2001
  June 2003)
• Setting Emilio Ribas Institute of Infectious
  Diseases, Sao Paulo, Brazil
• Inclusion criteria Patients with HIV infection,
  a first episode of TE (CDC criteria), and without
  concomitant CNS disorders

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Methods

• Clinical evaluations
• Days 1, 14, 42, and one year after the diagnosis
  of TE
• Radiological evaluations
• Days 1 and 10-14
• The clinical response was classified in
• a. Complete
• b. Partial

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Methods

• Treatment
• ? Sulphadiazine, pyrimethamine, and folinic
  acid
• ? HAART was introduced in the fourth week of
• anti - Toxoplasma treatment
• ? Secondary prophylaxis for TE was introduced
  after the sixth week of anti - Toxoplasma
  treatment

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Methods

• Statistical analysis
• The univariate analysis evaluated the association
  between individual variables and the outcome in
  the Day 42 of treatment.
• The OR was calculated with 95 CI. The values of
  P lt 0.05 were considered statistically
  significant.

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Results

• HIV-infected patients 1,138

Toxoplasmic encephalitis 115 (10)
Excluded 60 cases
Included 55 cases
Diagnosis Definitive 2 (4)
Presumptive 53 (96)
History of TE 47 Concomitant CNS disorders
7 Lost to follow-up 4 Lack of autorization 2
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Results

• ? TE was an HIV - indicative event in 19 (35)
  patients and was an AIDS-defining event in 41
  (75) patients
• ? History of HAART 12 (22) patients
• ? No. receiving of HAART at diagnosis of TE
• 4 (7) patients
• ? No. receiving prophylaxis at diagnosis of TE
• 6 (11) patients

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Clinical features
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Laboratory features

• IgG () (ELISA) 54 (98)

Radiological features
Typical findings 49 (77) patientsAtypical
findings 6 (23) patients
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Clinical outcome of 55 AIDS patients with TE
n 55
Deaths n 3
Partial response n 36
Complete response n 16
D 14
TE 2 NI 1
13
Partial response n 25
Complete response n 23
Deaths n 4
D 42
NI 4
48
Deaths n 2
PCP 1 IPD 1
Partial response n 21
Complete response n 23
1 YEAR
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Predictive factors of partial clinical response
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Conclusions

• 1. TE is still a common neurological complication
  in Brazilian AIDS patients, even in the late
  HAART era. This fact reflects a loss of
  diagnostic and therapeutic opportunities in
  HIV-infected patients.

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Conclusions

• 2. Features of severe neurological involvement
  and compromise of general status seem to be
  associated to a partial clinical response.
• 3. Early introduction of HAART seems to improve
  survival and reduce relapses of Brazilian AIDS
  patients with TE.