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

Nadia Cubas-Vega; Paola López Del-Tejo; Djane C Baia-da-Silva; Vanderson Souza Sampaio; Bruno Araújo Jardim; Monique Freire Santana; Luiz Carlos Lima Ferreira; Izabella Picinin Safe; Márcia A Araújo Alexandre; Marcus Vinícius Guimarães Lacerda; Wuelton Marcelo Monteiro; Fernando Val

doi:10.3389/fmed.2022.759091

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

Front Med (Lausanne). 2022 Feb 25:9:759091. doi: 10.3389/fmed.2022.759091. eCollection 2022.

Authors

Nadia Cubas-Vega^{1

2}, Paola López Del-Tejo^{1

2}, Djane C Baia-da-Silva^{1

2

3}, Vanderson Souza Sampaio^{1

2

4

5}, Bruno Araújo Jardim², Monique Freire Santana^{1

2}, Luiz Carlos Lima Ferreira^{1

2

6

7}, Izabella Picinin Safe^{1

2

7}, Márcia A Araújo Alexandre⁷, Marcus Vinícius Guimarães Lacerda^{1

2

3

7}, Wuelton Marcelo Monteiro^{1

2}, Fernando Val^{1

2

5

7}

Affiliations

¹ Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
² Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
³ Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil.
⁴ Gerência de Endemias, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil.
⁵ Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil.
⁶ Departameto de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, Brazil.
⁷ Departamento Clínico, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.

Abstract

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/mm³ 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.

Keywords: HIV/AIDS; Toxoplasma gondii; antiretroviral; complications; therapy; toxoplasmic encephalitis.