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La toxoplasmose au cours de l'infection par le virus de l'immunodéficience humaine : épidémiologie descriptive et facteurs prédictifs

Abstract : We have first studied extra-cerebral localizations of toxoplasmosis during HIV infection : 199 cases were recorded during a multicentric national survey begun in 1992, the greatest serie published today. Extra-cerebral toxoplasmosis was recorded in 1.5 to 2 % of French AIDS patients. All organs could be attacked. Diagnosis methods differ considering extra-cerebral localization. Mainly, at least one focal manifestation consistent with an acute disorder in the extracerebral organ infected with T.gondii was presented in patients presenting with an acute febrile syndrome. Ocular toxoplasmosis appeared the most frequent followed by pulmonary and disseminated toxoplasmosis. Treatment was the same as used during cerebral toxoplasmosis. Under treatrnent, outcome of ocular toxoplasmosis was similar as observed concerning cerebral toxoplasmosis. Pulmonary and disseminated toxoplasmosis appeared with a worse prognosis. Considering the similarities between cerebral and ocular toxoplasmosis, we have proposed to define «neurophthalmological toxoplasmosis» and «extra-neurophthalmological toxoplasmosis». The mean immunodepression level recorded in patients presenting with «extra-neurophthalmological toxoplasmosis» appeared greater than mainly observed in patients presenting with neurophthalmological toxoplasmosis. Parasitemia research appeared as a good diagnostic method during «extra-neurophthalmological toxoplasmosis». In conclusion, we have suggested that extra-cerebral toxoplasmosis were considered as an AIDS-defining opportunistic infection, as cerebral toxoplasmosis. Then, our studies have concemed cotrimoxazole (CTX) used as toxoplasmosis prophylaxis. Since 1992, use of CTX as first prophylaxis of pneumocystosis and toxoplasmosis was recommended considering results of several « on-treatment » analysis. In a first study, an « intent-to-treat» analysis did not confirm greater efficacy of CTX as toxoplasmosis prophylaxis when compared to pentarnidine. We have observed that adverse events to cotrimoxazole leading to stop this prophylaxis were predictive factors of subsequent occurrence of toxoplasmosis. The mechanism relating the adverse reactions occurrence and the subsequent AIDS progression remain not understood. Because a long time was recorded between adverse event occurrence and subsequent toxoplasmosis occurrence, direct link between CTX adverse events and T. gondii cyst reactivation did not appear as an adequate hypothesis. Some authors have suggested that CTX adverse events could reveal hyperstimulation of the immune system, hyperstimulation which could efficiently boost HIV replication and lead to accelerated destruction of the immune system and subsequent occurrence of toxoplasmosis. Our results confirrned that CTX adverse events were linked to subsequent occurrence of toxoplasmosis and to subsequent occurrence of other AIDS defining events.
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Christian Rabaud. La toxoplasmose au cours de l'infection par le virus de l'immunodéficience humaine : épidémiologie descriptive et facteurs prédictifs. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2000. Français. ⟨NNT : 2000NAN11308⟩. ⟨tel-01746414⟩

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