Antibody response of HIV-infected patients to latent, cerebral and recently acquired toxoplasmosis

  • L. Machala
  • M. Malý
  • Š. Hrdá
  • H. Rozsypal
  • M. Staňková
  • P. Kodym
Concise Article

Abstract

The aim of this longitudinal study with 626 HIV-infected patients was to evaluate the capability of serological tests in diagnosing the presence of Toxoplasma gondii infection in HIV-infected patients, as well as the potential impact of various treatment regimes on serological results. Low IgG antibody levels and stable or declining titres predominated. IgM positivity occurred in ten patients (one seroconversion, seven latent, two cerebral toxoplasmosis). Complement fixation test (CFT) titres ≥1:32 imply that the relative risk of cerebral toxoplasmosis is 6.84 (95% confidence interval [CI] 1.44–32.5) but with a predictive value of only 14.0% (95% CI 5.3–27.9). Values of specific antibodies are not biassed by antiretroviral treatment and/or prophylaxis for toxoplasmosis, and the detection of specific antibodies is very useful in the identification of T. gondii infection in the HIV-infected population, but the role of serology in predicting the clinical manifestation of T. gondii infection is limited.

Notes

Acknowledgements

This research was supported by the Grant Agency of the Ministry of Health of the Czech Republic (IGA MZ ČR, grant number NR 8283–3/2005). The authors are grateful to Blanka Širocká and Jarmila Sedláková for their excellent technical assistance.

References

  1. 1.
    Luft BJ, Remington JS (1992) Toxoplasmic encephalitis in AIDS. Clin Infect Dis 15:211–222PubMedGoogle Scholar
  2. 2.
    Belanger F, Derouin F, Grangeot-Keros L et al (1999) Incidence and risk factors of toxoplasmosis in a cohort of human immunodeficiency virus-infected patients: 1988–1995. HEMOCO and SEROCO Study Groups. Clin Infect Dis 28:575–581 doi: 10.1086/515147 PubMedCrossRefGoogle Scholar
  3. 3.
    Derouin F, Leport C, Pueyo S et al (1996) Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients. ANRS 005/ACTG 154 Trial Group. AIDS 10:1521–1527PubMedGoogle Scholar
  4. 4.
    Dannemann BR, Israelski DM, Leoung GS et al (1991) Toxoplasma serology, parasitemia and antigenemia in patients at risk for toxoplasmic encephalitis. AIDS 5:1363–1365 doi: 10.1097/00002030-199111000-00013 PubMedCrossRefGoogle Scholar
  5. 5.
    Israelski DM, Chmiel JS, Poggensee L et al (1993) Prevalence of Toxoplasma infection in a cohort of homosexual men at risk of AIDS and toxoplasmic encephalitis. J Acquir Immune Defic Syndr 6:414–418PubMedGoogle Scholar
  6. 6.
    Kodym P, Machala L, Roháčová H et al (2007) Evaluation of a commercial IgE ELISA in comparison with IgA and IgM ELISAs, IgG avidity assay and complement fixation for the diagnosis of acute toxoplasmosis. Clin Microbiol Infect 13:40–47 doi: 10.1111/j.1469-0691.2006.01564.x PubMedCrossRefGoogle Scholar
  7. 7.
    Bartlett JG, Gallant JE (2005) 2005–2006 Medical management of HIV infection. Johns Hopkins University Press, BaltimoreGoogle Scholar
  8. 8.
    Amemiya T (1984) Tobit models: a survey. J Econometrics 24:3–61 doi: 10.1016/0304-4076(84)90074-5 CrossRefGoogle Scholar
  9. 9.
    Kodym P, Malý M, Švandová E et al (2001) Toxoplasma in the Czech Republic 1923–1999: first case to widespread outbreak. Int J Parasitol 31:125–132Google Scholar
  10. 10.
    Kodym P, Hrdá S, Machala L et al (2006) Prevalence and incidence of Toxoplasma infection in HIV-positive patients in the Czech Republic. J Eukaryot Microbiol 53:S160–S161 doi: 10.1111/j.1550-7408.2006.00215.x PubMedCrossRefGoogle Scholar
  11. 11.
    Colombo FA, Vidal JE, Penalva de Oliveira AC et al (2005) Diagnosis of cerebral toxoplasmosis in AIDS patients in Brazil: importance of molecular and immunological methods using peripheral blood samples. J Clin Microbiol 43:5044–5047 doi: 10.1128/JCM.43.10.5044-5047.2005 PubMedCrossRefGoogle Scholar
  12. 12.
    Reiter-Owona I, Bialek R, Rockstroh J et al (1998) The probability of acquiring primary Toxoplasma infection in HIV-infected patients: results of an 8-year retrospective study. Infection 26:20–25 doi: 10.1007/BF02768747 PubMedCrossRefGoogle Scholar
  13. 13.
    Zufferey J, Sugar A, Rudaz P et al (1993) Prevalence of latent toxoplasmosis and serological diagnosis of active infection in HIV-positive patients. Eur J Clin Microbiol Infect Dis 12:591–595 doi: 10.1007/BF01973636 PubMedCrossRefGoogle Scholar
  14. 14.
    Arendt G, von Giesen H, Hefter H et al (1999) Long-term course and outcome in AIDS patients with cerebral toxoplasmosis. Acta Neurol Scand 100:178–184PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • L. Machala
    • 1
  • M. Malý
    • 2
  • Š. Hrdá
    • 3
  • H. Rozsypal
    • 1
  • M. Staňková
    • 1
  • P. Kodym
    • 3
  1. 1.University Hospital Bulovka, AIDS CenterPrague 8Czech Republic
  2. 2.Department of Biostatistics and InformaticsNational Institute of Public HealthPrague 10Czech Republic
  3. 3.National Reference Laboratory for ToxoplasmosisNational Institute of Public HealthPrague 10Czech Republic

Personalised recommendations