EPIDEMIOLOGIC CHARACTERISTICS OF TOXOPLAS MIC ENCEPHALITIS IN 399 HIV-INFECTED PATIENTS FOLLOWED FROM 1983 TO 1994

Objective. -To describe the epidemiological characteristics of toxopla smic encephalitis in HN-infected patients with a more than 12-year fol low-up. Methods. -From a data base of 1,628 AIDS subjects hospitalized from 1983 to 1994, we studied the epidemiological characteristics of 399 patients with toxoplasmic encephalitis. Diagnosis of toxoplasmic e ncephalitis was based on the association of central neurological disor ders, typical lesions on CT scan or MRI, and favorable outcome under a ppropriate toxoplasmosis therapy. Results. -Four hundred sixty-four ca ses of toxoplasmic encephalitis were reported in 399 patients (24.5% o f the patients with AIDS). The overall incidence was 20.5 per 100 pati ents-year. Toxoplasmic encephalitis was the first AIDS defining event in 51% of the cases and revealed HN infection in 13% of the cases. In the remaining 49%, the mean delay from AIDS diagnosis to toxoplasmic e ncephalitis was 13 months (range: 1-71 months). At the time of diagnos is, mean CD4 count was 44/mm(3) (range: 0-408/mm(3)). Antibodies to To xoplasma gondii were found in 97% of the cases. Before the first episo de of toxoplasmic encephalitis, 58% of the patients were given antiret roviral therapy (mean: 17.8 months; range: 1-64 months). Of the 399 pa tients with toxoplasmic encephalitis, 366 (92%) did not receive any pr imary toxoplasmosis prophylaxis. Among them, 205 (56%) did not receive any drug prophylaxis, and 161 (44%) had Pneumocystis carinii pneumoni a prophylaxis alone (aerosolized pentamidine). Thirty-three failures, were observed (8%) with cotrimoxazole: 14 cases (3%) were considered t o have irregular compliance. Sixty-five relapses were observed in 52 p atients. At the end of the study 334 patients had died (84%). The medi an survival was 11.4 months (95% confidence interval, range: 10.4-12.4 months). Conclusions. -Toxoplasmic encephalitis incidence has decreas ed since the introduction of appropriate drug prophylaxis. (C) 1998, E lsevier, Paris.