Frontiers in Medicine (Feb 2022)

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

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

DOI
https://doi.org/10.3389/fmed.2022.759091
Journal volume & issue
Vol. 9

Abstract

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BackgroundEvidence 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.MethodsWe 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.ResultsFour 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.ConclusionIn patients with AIDS and TE, early ART initiation might have a detrimental influence on the occurrence of sequelae.

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