Discontinuation of maintenance therapy against toxoplasma encephalitis in AIDS patients with sustained response to anti-retroviral therapy

• Published in: Clinical microbiology and infection Vol. 12; no. 7; pp. 666 - 671
• Main Authors: Bertschy, S., Opravil, M., Cavassini, M., Bernasconi, E., Schiffer, V., Schmid, P., Flepp, M., Chave, J-P., Christen, A., Furrer, H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01.07.2006; Blackwell Publishing Ltd; Blackwell
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; Animals; Anti-Retroviral Agents - therapeutic use; Antiprotozoal Agents - administration & dosage; Biological and medical sciences; CD4 cell count; CD4 Lymphocyte Count; discontinuation of therapy; encephalitis; Female; Human immunodeficiency virus; Human protozoal diseases; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Parasitic diseases; Prospective Studies; Protozoal diseases; Recurrence; Switzerland; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral - drug therapy; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Switzerland; CD4 cell count; human immunodeficiency virus; AIDS; discontinuation of therapy; encephalitis; toxoplasmosis; Protozoal disease; Immunological investigation; Toxoplasmosis; Maintenance treatment; T-Lymphocyte; Human; Immunopathology; Protozoa; Encephalitis; Apicomplexa; Nervous system diseases; Retroviridae; Parasitosis; Immune deficiency; Lentivirus; Cerebral disorder; Infection; Virus; Numeration; Toxoplasma; Viral disease; Central nervous system disease; Human immunodeficiency virus
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2006.01459.x

Discontinuation of maintenance therapy against toxoplasma encephalitis (TE) for individuals infected with human immunodeficiency virus (HIV) who are receiving successful anti-retroviral therapy is considered safe. Nevertheless, there are few published studies concerning this issue. Within the setting of the Swiss HIV Cohort Study, this report describes a prospective study of discontinuation of maintenance therapy against TE in patients with a sustained increase of CD4 counts to > 200 cells/μL and 14% of total lymphocytes, and no active lesions on cerebral magnetic resonance imaging (MRI). In addition to clinical evaluation, cerebral MRI was performed at baseline, and 1 and 6 months following discontinuation. Twenty-six AIDS patients with a history of TE agreed to participate, but three patients (11%) could not be enrolled because they still showed enhancing cerebral lesions without a clinical correlate. One patient refused MRI after 6 months while clinically asymptomatic. Among the remaining 22 patients who discontinued maintenance therapy, one relapsed after 3 months. During a total follow-up of 58 patient-years, there was no TE relapse among the patients who had remained clinically and radiologically free of relapse during the study. Thus, discontinuation of maintenance therapy against TE was generally safe, but may fail in a minority of patients. Patients who remain clinically and radiologically free of relapse at 6 months after discontinuation are unlikely to experience a relapse of TE.