Leport C, Franck J, Chene G, Derouin F, Ecobichon J L, Pueyo S, Miro J M, Luft B J, Morlat P, Dumon H
Laboratoire de Recherche en Pathologie Infectieuse, Faculté Xavier Bichat, 75018 Paris, France.
Clin Diagn Lab Immunol. 2001 May;8(3):579-84. doi: 10.1128/CDLI.8.3.579-584.2001.
In order to define more accurately human immunodeficiency virus-infected patients at risk of developing toxoplasmic encephalitis (TE), we assessed the prognostic significance of the anti-Toxoplasma gondii immunoglobulin G (IgG) immunoblot profile, in addition to AIDS stage, a CD4(+) cell count <50/mm(3), and an antibody titer > or =150 IU/ml, in patients with CD4 cell counts <200/mm(3) and seropositive for T. gondii. Baseline serum samples from 152 patients included in the placebo arm of the ANRS 005-ACTG 154 trial (pyrimethamine versus placebo) were used. The IgG immunoblot profile was determined using a Toxoplasma lysate and read using the Kodak Digital Science 1D image analysis software. Mean follow-up was 15.1 months, and the 1-year incidence of TE was 15.9%. The cumulative probability of TE varied according to the type and number of anti-T. gondii IgG bands and reached 65% at 12 months for patients with IgG bands of 25 and 22 kDa. In a Cox model adjusted for age, gender, Centers for Disease Control and Prevention (CDC) clinical stage, and CD4 and CD8 cell counts, the incidence of TE was higher when the IgG 22-kDa band (hazard ratio [HR] = 5.4; P < 0.001), the IgG 25-kDa band (HR = 4.7; P < 0.001), or the IgG 69-kDa band (HR = 3.4; P < 0.001) was present and was higher for patients at CDC stage C (HR = 4.9; P < 0.001). T. gondii antibody titer and CD4 cell count were not predictive of TE. Thus, detection of IgG bands of 25, 22, and/or 69 kDa may be helpful for deciding when primary prophylaxis for TE should be started or discontinued, especially in the era of highly active antiretroviral therapy.
为了更准确地界定有发生弓形虫脑病（TE）风险的人类免疫缺陷病毒感染患者，我们评估了抗弓形虫免疫球蛋白G（IgG）免疫印迹图谱的预后意义，此外还评估了艾滋病分期、CD4(+)细胞计数<50/mm³以及抗体滴度≥150 IU/ml对CD4细胞计数<200/mm³且弓形虫血清学阳性患者的影响。使用了ANRS 005-ACTG 154试验（乙胺嘧啶与安慰剂对照）安慰剂组中152例患者的基线血清样本。使用弓形虫裂解物测定IgG免疫印迹图谱，并使用柯达数字科学1D图像分析软件进行读取。平均随访时间为15.1个月，TE的1年发病率为15.9%。TE的累积概率因抗弓形虫IgG条带的类型和数量而异，对于有25 kDa和22 kDa IgG条带的患者，12个月时达到65%。在根据年龄、性别、疾病控制和预防中心（CDC）临床分期以及CD4和CD8细胞计数进行调整的Cox模型中，当存在IgG 22-kDa条带（风险比[HR]=5.4；P<0.001）、IgG 25-kDa条带（HR=4.7；P<0.001）或IgG 69-kDa条带（HR=3.4；P<0.001）时，TE的发病率更高，并且CDC C期患者的发病率更高（HR=4.9；P<0.001）。弓形虫抗体滴度和CD4细胞计数不能预测TE。因此，检测25、22和/或69 kDa的IgG条带可能有助于决定何时开始或停止TE的一级预防，尤其是在高效抗逆转录病毒治疗时代。
