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

Authors
 Ki Hyun Lee  ;  Awachana Jiamsakul  ;  Sasisopin Kiertiburanakul  ;  Rohidas Borse  ;  Vohith Khol  ;  Evy Yunihastuti  ;  Iskandar Azwa  ;  I Ketut Agus Somia  ;  Romanee Chaiwarith  ;  Thach Ngoc Pham  ;  Suwimon Khusuwan  ;  Cuong Duy Do  ;  Nagalingeswaran Kumarasamy  ;  Yasmin Gani  ;  Rossana Ditangco  ;  Oon Tek Ng  ;  Sanjay Pujari  ;  Man Po Lee  ;  Anchalee Avihingsanon  ;  Hsin-Pai Chen  ;  Fujie Zhang  ;  Junko Tanuma  ;  Jeremy Ross  ;  Jun Yong Choi 
Citation
 PLOS ONE, Vol.19(7) : e0306245, 2024-07 
Journal Title
PLOS ONE
Issue Date
2024-07
MeSH
Adult ; Asia / epidemiology ; Case-Control Studies ; Female ; HIV Infections* / complications ; HIV Infections* / epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Toxoplasma ; Toxoplasmosis* / complications ; Toxoplasmosis* / epidemiology
Abstract
Introduction 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. Copyright: © 2024 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Files in This Item:
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DOI
10.1371/journal.pone.0306245
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Ki Hyun(이기현)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/200983
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