Risk factors for toxoplasmosis in people living with HIV in the Asia-Pacific region

• Published in: PloS one Vol. 19; no. 7; p. e0306245
• Main Authors: Lee, Ki Hyun, Jiamsakul, Awachana, Kiertiburanakul, Sasisopin, Borse, Rohidas, Khol, Vohith, Yunihastuti, Evy, Azwa, Iskandar, Somia, I Ketut Agus, Chaiwarith, Romanee, Pham, Thach Ngoc, Khusuwan, Suwimon, Do, Cuong Duy, Kumarasamy, Nagalingeswaran, Gani, Yasmin, Ditangco, Rossana, Ng, Oon Tek, Pujari, Sanjay, Lee, Man Po, Avihingsanon, Anchalee, Chen, Hsin-Pai, Zhang, Fujie, Tanuma, Junko, Ross, Jeremy, Choi, Jun Yong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.07.2024
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Asia - epidemiology; Biology and Life Sciences; Case-Control Studies; CD4 antigen; Control methods; Cotrimoxazole; Diagnosis; DNA polymerases; Enrollments; Epidemiology; Ethics; Female; Health aspects; Hepatitis B; Heterosexuality; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - complications; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Immune reconstitution; Immune system; Infection; Infections; Inhibitors; Latent infection; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Non-nucleoside reverse transcriptase inhibitors; Nucleoside reverse transcriptase inhibitors; Nucleosides; Population; Prevalence; Prospective Studies; Protozoa; Retrospective Studies; Risk Factors; RNA-directed DNA polymerase; Serology; Socioeconomic factors; Socioeconomic status; Software; Toxoplasma; Toxoplasmosis; Toxoplasmosis - complications; Toxoplasmosis - epidemiology; Viruses; Asia; East Asia; Thailand; Australia; India; Asia-Pacific region; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0306245

Toxoplasma gondii can cause symptomatic toxoplasmosis in immunodeficient hosts, including in people living with human immunodeficiency virus (PLWH), mainly because of the reactivation of latent infection. We assessed the prevalence of toxoplasmosis and its associated risk factors in PLWH in the Asia-Pacific region using data from the TREAT Asia Human Immunodeficiency Virus (HIV) Observational Database (TAHOD) of the International Epidemiology Databases to Evaluate AIDS (IeDEA) Asia-Pacific. This study included both retrospective and prospective cases of toxoplasmosis reported between 1997 and 2020. A matched case-control method was employed, where PLWH diagnosed with toxoplasmosis (cases) were each matched to two PLWH without a toxoplasmosis diagnosis (controls) from the same site. Sites without toxoplasmosis were excluded. Risk factors for toxoplasmosis were analyzed using conditional logistic regression. A total of 269/9576 (2.8%) PLWH were diagnosed with toxoplasmosis in 19 TAHOD sites. Of these, 227 (84%) were reported retrospectively and 42 (16%) were prospective diagnoses after cohort enrollment. At the time of toxoplasmosis diagnosis, the median age was 33 years (interquartile range 28-38), and 80% participants were male, 75% were not on antiretroviral therapy (ART). Excluding 63 out of 269 people without CD4 values, 192 (93.2%) had CD4 ≤200 cells/μL and 162 (78.6%) had CD4 ≤100 cells/μL. By employing 538 matched controls, we found that factors associated with toxoplasmosis included abstaining from ART (odds ratio [OR] 3.62, 95% CI 1.81-7.24), in comparison to receiving nucleoside reverse transcriptase inhibitors plus non-nucleoside reverse transcriptase inhibitors, HIV exposure through injection drug use (OR 2.27, 95% CI 1.15-4.47) as opposed to engaging in heterosexual intercourse and testing positive for hepatitis B virus surface antigen (OR 3.19, 95% CI 1.41-7.21). Toxoplasmosis was less likely with increasing CD4 counts (51-100 cells/μL: OR 0.41, 95% CI 0.18-0.96; 101-200 cells/μL: OR 0.14, 95% CI 0.06-0.34; >200 cells/μL: OR 0.02, 95% CI 0.01-0.06), when compared to CD4 ≤50 cells/μL. Moreover, the use of prophylactic cotrimoxazole was not associated with toxoplasmosis. Symptomatic toxoplasmosis is rare but still occurs in PLWH in the Asia-Pacific region, especially in the context of delayed diagnosis, causing advanced HIV disease. Immune reconstitution through early diagnosis and ART administration remains a priority in Asian PLWH.