背景:弓形虫可在免疫缺陷宿主中引起症状性弓形虫病,包括患有人类免疫缺陷病毒(PLWH)的人,主要是因为潜伏感染的重新激活。我们使用国际流行病学数据库(IEDEA)亚太地区的TREATAsia人类免疫缺陷病毒(HIV)观察数据库(TAHOD)的数据评估了亚太地区PLWH中弓形虫病的患病率及其相关危险因素。
方法:本研究包括1997年至2020年报告的回顾性和前瞻性弓形虫病病例。采用匹配的病例对照方法,其中诊断为弓形虫病的PLWH(病例)分别与来自同一部位的两个无弓形虫病诊断的PLWH(对照)相匹配。没有弓形虫病的部位被排除。使用条件逻辑回归分析弓形虫病的危险因素。
结果:共有269/9576(2.8%)PLWH在19个TAHOD部位被诊断为弓形虫病。其中,227例(84%)回顾性报道,42例(16%)是队列登记后的前瞻性诊断。在弓形虫病诊断时,中位年龄为33岁(四分位距28-38),80%的参与者是男性,75%的患者没有接受抗逆转录病毒治疗(ART)。在269个没有CD4值的人中,包括63个,192例(93.2%)CD4≤200细胞/μL,162例(78.6%)CD4≤100细胞/μL。通过使用538个匹配的控件,我们发现与弓形虫病相关的因素包括戒除ART(比值比[OR]3.62,95%CI1.81-7.24),与接受核苷逆转录酶抑制剂加非核苷逆转录酶抑制剂相比,通过注射药物接触HIV(OR2.27,95%CI1.15-4.47),而不是进行异性性交和乙型肝炎病毒表面抗原检测呈阳性(OR3.19,95%CI1.41-7.21)。随着CD4计数的增加,弓形虫病的可能性较小(51-100细胞/μL:OR0.41,95%CI0.18-0.96;101-200细胞/μL:OR0.14,95%CI0.06-0.34;>200细胞/μL:OR0.02,95%CI0.01-0.06),当与CD4≤50细胞/μL相比时。此外,预防性使用复方新诺明与弓形虫病无关.
结论:症状性弓形虫病很少见,但在亚太地区的PLWH中仍然存在,特别是在延迟诊断的情况下,导致晚期HIV疾病。通过早期诊断和ART管理的免疫重建仍然是亚洲PLWH的优先事项。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.