van Bilsen Ward P H, van den Berg Charlotte H S B, Rijnders Bart J A, Brinkman Kees, Mulder Jan W, Gelinck Luc B S, Hoepelman Andy I M, Wit Ferdinand W N M, van de Beek Diederik, Prins Jan M
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.
AIDS. 2017 Jun 19;31(10):1415-1424. doi: 10.1097/QAD.0000000000001492.
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).
A historical multicenter cohort study.
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.
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 × 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.
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.
调查开始联合抗逆转录病毒治疗（cART）的患者中与弓形虫性脑炎（TE）相关的免疫重建炎症综合征（IRIS）的发生率及危险因素。
一项历史性多中心队列研究。
纳入1996年至2016年间在荷兰六家医院诊断为弓形虫性脑炎的所有HIV感染患者。使用预先定义的IRIS标准诊断TE-IRIS。我们将矛盾性TE-IRIS（基础治疗感染恶化）与揭露性TE-IRIS（cART开始后亚临床感染被揭露）区分开来。我们比较了发生和未发生矛盾性TE-IRIS的患者之间的CD4细胞计数、血浆病毒载量以及开始cART的时间。
共纳入211例弓形虫性脑炎病例。在143例有矛盾性TE-IRIS风险的病例中，我们识别出5例矛盾性TE-IRIS（3.5%）。在其他6例病例中，由于二级弓形虫预防措施不足，我们无法区分矛盾性TE-IRIS与疾病复发。发生或未发生矛盾性TE-IRIS的患者在开始弓形虫性脑炎治疗和开始cART之间的时间没有差异（P = 0.50）。在2228例CD4细胞计数低于200×10⁶细胞/升且接受了充分一级预防的开始cART的患者中，我们识别出8例揭露性TE-IRIS（0.36%）。在其他6例患者中，由于未接受针对弓形虫的充分一级预防，揭露性TE-IRIS无法与新发生的弓形虫性脑炎区分开来。
在该队列中，揭露性TE-IRIS很少见，而矛盾性TE-IRIS确实更常发生。我们发现开始cART的时间与矛盾性TE-IRIS的发生之间没有关系。
