Impaired CD4-cell immune reconstitution upon HIV therapy in patients with toxoplasmic encephalitis compared to patients with pneumocystis pneumonia as AIDS indicating disease

Abstract

Objectives There is only little data on immune reconstitution in antiretroviral naïve AIDS-patients with toxoplasmosis. The observation of several cases with reduced increase of CD4-cells upon start of antiretroviral treatment (ART) prompted us to investigate the topic using the ClinSurv cohort. Methods 17 German HIV treatment centers contribute to ClinSurv, a multicentre observational cohort under the auspices of the Robert Koch Institute. We retrospectively selected all antiretroviral-naïve patients with toxoplasmic encephalitis (TE) and -as comparator group -with pneumocystosis (PCP) between January 1999 and December 2005. Results A total of 257 patients were included in the analysis, 61 with TE and 196 with PCP. Demographic baseline data showed differences with regard to gender, transmission group, and baseline CD4 + counts (60.9 vs. 44.7/μl, p = 0.022). After ART-initiation the increase in CD4 + lymphocytes was lower in the TE-versus the PCP-group in the first, second and fourth three-month-period (74.4 vs. 120.3/μl, p = 0.006; 96.6 vs. 136.2/μl, p = 0.021; 156.5 vs. 211.5/μl, p = 0.013). Viral load (VL) was higher in the PCP-group at baseline (4.46 log 10 cop/ml vs. 5.00 log 10 cop/ml, p = 0.008), while virological success of ART was equal. Conclusions Our data show for the first time that the average CD4 + T-cell increase of patients with toxoplasmosis is impaired compared to PCP-patients. Most clinicians would not be prepared to discontinue follow-up TE-therapy unless CD4 + counts of 200/μl are reached. Explanation for our finding might be the myelosuppressive side effect of pyrimethamine, possible interactions of toxoplasmosis therapy with ART, or an unknown direct biological influence of toxoplasmosis on immune restoration.

Cohort profile: the German ClinSurv HIV project - a multicentre open clinical cohort study supplementing national HIV surveillance

“…Strategies to increase CD4 counts to>100 cells/μL proved to be most effective in preventing ADEs [19]. The data showed that the average CD4 count increase was slower in patients with opportunistic toxoplasmosis infection compared with those with Pneumocystis jirovecii infection [20]. The transmission risk category MSM and incomplete viral suppression were found to be strong predictors of the development of AIDS‐related lymphoma [21].…”

Microbes, Viruses and Parasites in AIDS Process

“…They can be transmitted through the placenta from mother to fetus, by blood transfusion, or by organ transplantation. (Kastenbauer et al, 2009). As the number of AIDS-associated CT cases treated with HAART increases, the complications of IRIS-CT may become more common and easily recognizable, particularly in areas where toxoplasmosis is endemic.…”