Bertschy S, Opravil M, Cavassini M, Bernasconi E, Schiffer V, Schmid P, Flepp M, Chave J-P, Christen A, Furrer H
Division of Infectious Diseases, University Hospital Berne, Bern, Switzerland.
Clin Microbiol Infect. 2006 Jul;12(7):666-71. doi: 10.1111/j.1469-0691.2006.01459.x.
Discontinuation of maintenance therapy against toxoplasma encephalitis (TE) for individuals infected with human immunodeficiency virus (HIV) who are receiving successful anti-retroviral therapy is considered safe. Nevertheless, there are few published studies concerning this issue. Within the setting of the Swiss HIV Cohort Study, this report describes a prospective study of discontinuation of maintenance therapy against TE in patients with a sustained increase of CD4 counts to > 200 cells/microL and 14% of total lymphocytes, and no active lesions on cerebral magnetic resonance imaging (MRI). In addition to clinical evaluation, cerebral MRI was performed at baseline, and 1 and 6 months following discontinuation. Twenty-six AIDS patients with a history of TE agreed to participate, but three patients (11%) could not be enrolled because they still showed enhancing cerebral lesions without a clinical correlate. One patient refused MRI after 6 months while clinically asymptomatic. Among the remaining 22 patients who discontinued maintenance therapy, one relapsed after 3 months. During a total follow-up of 58 patient-years, there was no TE relapse among the patients who had remained clinically and radiologically free of relapse during the study. Thus, discontinuation of maintenance therapy against TE was generally safe, but may fail in a minority of patients. Patients who remain clinically and radiologically free of relapse at 6 months after discontinuation are unlikely to experience a relapse of TE.
对于正在接受成功抗逆转录病毒治疗的人类免疫缺陷病毒（HIV）感染者，停止针对弓形虫性脑炎（TE）的维持治疗被认为是安全的。然而，关于这个问题的已发表研究很少。在瑞士HIV队列研究的背景下，本报告描述了一项前瞻性研究，该研究针对CD4细胞计数持续增加至>200个细胞/微升且占总淋巴细胞的14%，并且脑磁共振成像（MRI）上无活动性病变的患者停止针对TE的维持治疗。除了临床评估外，在基线时以及停止治疗后1个月和6个月进行脑MRI检查。26名有TE病史的艾滋病患者同意参与，但3名患者（11%）因仍显示脑部有强化病变且无临床相关表现而无法纳入。1名患者在6个月后临床上无症状但拒绝进行MRI检查。在其余22名停止维持治疗的患者中，1名在3个月后复发。在总共58个患者年的随访期间，在研究期间临床和影像学上均未复发的患者中没有TE复发。因此，停止针对TE的维持治疗总体上是安全的，但少数患者可能会失败。停止治疗6个月后临床和影像学上均未复发的患者不太可能发生TE复发。
