Cubas-Vega Nadia, López Del-Tejo Paola, Baia-da-Silva Djane C, Sampaio Vanderson Souza, Jardim Bruno Araújo, Santana Monique Freire, Lima Ferreira Luiz Carlos, Safe Izabella Picinin, Alexandre Márcia A Araújo, Lacerda Marcus Vinícius Guimarães, Monteiro Wuelton Marcelo, Val Fernando
Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
Front Med (Lausanne). 2022 Feb 25;9:759091. doi: 10.3389/fmed.2022.759091. eCollection 2022.
Evidence 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.
We 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.
Four 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/mm and 0.09, respectively. Mortality rate and presence of sequelae were 4.9% ( = 23) and 41.6% ( = 195), respectively. Mortality was similar between groups ( = 0.18), although the EIT group had the highest prevalence of sequelae at discharge ( = 0.04). The hazard ratio for death at 16 weeks with DIT was 2.3 ( = 0.18). The necessity for intensive care unit admission, mechanical ventilation, and cardiopulmonary resuscitation were similar between groups.
In patients with AIDS and TE, early ART initiation might have a detrimental influence on the occurrence of sequelae.
关于在存在弓形虫性脑炎（TE）的情况下启动抗逆转录病毒疗法（ART）的最佳时机的证据很少。我们比较了在巴西同时感染HIV和TE的人群中，早期与延迟启动ART对出院时死亡率和神经并发症的影响。
我们回顾性评估了位于亚马孙州马瑙斯的一家转诊中心9年的住院数据。所有未接受过ART治疗的住院患者被分为早期启动治疗（EIT）组（0 - 4周）和延迟启动治疗（DIT）组（>4周）。使用卡方检验和16周时的死亡率对两组进行比较。
共纳入469例患者，其中357例（76.1%）属于EIT组。CD4淋巴细胞计数中位数和CD4/CD8比值分别为53个细胞/mm³和0.09。死亡率和后遗症发生率分别为4.9%（n = 23）和41.6%（n = 195）。两组之间的死亡率相似（P = 0.18），尽管EIT组出院时后遗症的患病率最高（P = 0.04）。DIT组16周时死亡的风险比为2.3（P = 0.18）。两组之间入住重症监护病房、机械通气和心肺复苏的必要性相似。
在患有艾滋病和TE的患者中，早期启动ART可能对后遗症的发生有不利影响。
