PMID- 28375874
OWN - NLM
STAT- MEDLINE
DCOM- 20180219
LR  - 20180523
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 10
DP  - 2017 Jun 19
TI  - Immune reconstitution inflammatory syndrome associated with toxoplasmic 
      encephalitis in HIV-infected patients.
PG  - 1415-1424
LID - 10.1097/QAD.0000000000001492 [doi]
AB  - OBJECTIVES: To investigate the incidence and risk factors of immune 
      reconstitution inflammatory syndrome (IRIS) associated with toxoplasmic 
      encephalitis (TE) in patients starting combination antiretroviral therapy (cART). 
      DESIGN: A historical multicenter cohort study. METHODS: We included all 
      HIV-infected patients diagnosed with toxoplasmic encephalitis in six Dutch 
      hospitals between 1996 and 2016. Diagnosis of TE-IRIS was made using predefined 
      IRIS criteria. We distinguished paradoxical TE-IRIS (worsening of underlying 
      treated infection) from unmasking TE-IRIS (unmasking of subclinical infection 
      after start of cART). We compared CD4 cell count, plasma viral load and timing of 
      cART initiation between patients with and without paradoxical TE-IRIS. RESULTS: A 
      total of 211 toxoplasmic encephalitis cases were included. Among 143 cases at 
      risk for paradoxical TE-IRIS, we identified five cases of paradoxical TE-IRIS 
      (3.5%). In six other cases, we could not differentiate paradoxical TE-IRIS from 
      recurrence of disease due to inadequate secondary Toxoplasma prophylaxis. There 
      was no difference in time between start of toxoplasmic encephalitis treatment and 
      cART initiation for patients who did or did not develop paradoxical TE-IRIS 
      (P = 0.50). Within the group of 2228 patients who started cART while having a CD4 
      cell count below 200 x 10 cells/l and receiving adequate primary prophylaxis, we 
      identified eight cases of unmasking TE-IRIS (0.36%). Unmasking TE-IRIS could not 
      be differentiated from a newly occurring toxoplasmic encephalitis in six other 
      patients, as they were not receiving adequate primary prophylaxis against 
      Toxoplasma. CONCLUSION: Unmasking TE-IRIS was rare in this cohort, whereas 
      paradoxical TE-IRIS did occur more often. We found no relationship between the 
      timing of cART initiation and the occurrence of paradoxical TE-IRIS.
FAU - van Bilsen, Ward P H
AU  - van Bilsen WPH
AD  - aDivision of Infectious Diseases, Department of Internal Medicine, Academic 
      Medical Center, Amsterdam bSection of Infectious Diseases, Department of Internal 
      Medicine, Erasmus Medical Center, Rotterdam cDivision of Infectious Diseases, 
      Department of Internal Medicine, OLVG, Amsterdam dDivision of Infectious 
      Diseases, Department of Internal Medicine, Slotervaart Medical Center, Amsterdam 
      eDivision of Infectious Diseases, Department of Internal Medicine, Haaglanden 
      Medical Center, Den Haag fDivision of Infectious Diseases, Department of Internal 
      Medicine, University Medical Center, Utrecht gDutch HIV Monitoring Foundation 
      hDepartment of Neurology, Amsterdam Neuroscience, Academic Medical Center, 
      Amsterdam, The Netherlands.
FAU - van den Berg, Charlotte H S B
AU  - van den Berg CHSB
FAU - Rijnders, Bart J A
AU  - Rijnders BJA
FAU - Brinkman, Kees
AU  - Brinkman K
FAU - Mulder, Jan W
AU  - Mulder JW
FAU - Gelinck, Luc B S
AU  - Gelinck LBS
FAU - Hoepelman, Andy I M
AU  - Hoepelman AIM
FAU - Wit, Ferdinand W N M
AU  - Wit FWNM
FAU - van de Beek, Diederik
AU  - van de Beek D
FAU - Prins, Jan M
AU  - Prins JM
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Cohort Studies
MH  - Encephalitis/*diagnosis/*pathology
MH  - Female
MH  - HIV Infections/*complications/drug therapy/pathology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*epidemiology/*etiology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Netherlands/epidemiology
MH  - Toxoplasmosis, Cerebral/*diagnosis/*pathology
MH  - Viral Load
EDAT- 2017/04/05 06:00
MHDA- 2018/02/20 06:00
CRDT- 2017/04/05 06:00
PHST- 2017/04/05 06:00 [pubmed]
PHST- 2018/02/20 06:00 [medline]
PHST- 2017/04/05 06:00 [entrez]
AID - 10.1097/QAD.0000000000001492 [doi]
PST - ppublish
SO  - AIDS. 2017 Jun 19;31(10):1415-1424. doi: 10.1097/QAD.0000000000001492.