Clinical characteristics, laboratory findings and outcomes of Toxoplasma gondii infection in HIV/AIDS patients at Bach Mai Hospital

 https://doi.org/10.52322/jocmbmh.07.en.11

ABSTRACT

Introduction: Toxoplasma gondii is one of the most common and widespread opportunistic infections that affect individuals with advanced HIV infection.

Objectives: Assess the clinical manifestations, laboratory results and treatment outcomes of HIV/AIDS with Toxoplasma gondii infection enrolled to Bach Mai Hospital from 2009 to 2018.

Material and Methods: We conducted a cross-sectional study among 64 HIV/AIDS patients with Toxoplasma gondii encephalitis from 2009 to 2018 at Bach Mai Hospital. Staff at the HIV outpatient clinic collected data from patients' medical records based on a pre-designed clinical report form. Kaplan-Meier survival analysis was used to estimate mortality rate among patients.

Results: Headache was the most common clinical presentation in patients infected with Toxoplasma gondii in the study (75%). Meanwhile, cranial nerve palsy was also quite common with 43.75%. The proportion of patients with weight loss and fever was 39.06% and 37.5%, respectively. There were 63/64 patients had advanced HIV at baseline with CD4 < 200 cells/mm3. The percentage of patients with CD4<50 cells/mm3 was up to 56.25% and from 51-100 cells/mm3 was 29.69%. Among 33 patients tested for viral load at baseline, there was 60.61% had viral loads above 100 thousand copies/mL. There were 08/64 deaths during the period from 2009 to 2018 with an overall fatality-rate of 12.5%. The cumulative mortality rate was 3.08/100 patient-years. The mean time of death from detection of Toxoplasma gondii infection was 86 days, with 03 cases identified as presumptive events on the background of Toxoplasma gondii disease. Most deaths occur within the first year of detection. Cotrimoxazole was given to all patients, as well as ARV treatment was initiated as soon as possible. At 24 months, the patient's median CD4 had increased above 200 cells/mm3.

Conclusion: Headache and cranial nerve palsy were the two common clinical symptoms among HIV patients infected with T. gondii. Early cotrimoxazole prophylaxis was found to be highly effective to prevent mortality among HIV patients.

Keywords: Clinical features, laboratory findings, HIV, AIDS, Toxoplasma gondii, T. gondii, Vietnam.

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