Acometimento ocular em pacientes com AIDS e toxoplasmose do sistema nervoso central: antes e depois do HAART

Abstract

To describe the ophthalmologic involvement in patients with Acquired Immunodeficiency Syndrome-AIDS and central nervous system toxoplasmosis comparing the period before and after highly active antiretroviral therapy (HAART). In a retrospective study, we compared 118 Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis who were examined at our institution before highly active antiretroviral therapy (from 1994-1996) with 24 patients with Acquired Immunodeficiency Syndrome and central nervous system toxoplasmosis who were being treated with highly active antiretroviral therapy (from 1996-1999). All patients were submitted to a complete ophthalmological examination as well as specific tests to confirm the diagnosis and there was no intersection between the groups. In the pre-highly active antiretroviral therapy group, it was found that 23% of the patients with central nervous system toxoplasmosis had also ocular toxoplasmosis. Ocular involvement was bilateral in 37.2% of the cases. In the group of patients receiving highly active antiretroviral therapy, who had an average CD4 of 256 cells/mm(3) and average of viral load of 52,620 copies, 16.6% had concomitant ocular and central nervous system toxoplasmosis. Ocular involvement was bilateral in 50% of the cases. Acquired Immunodeficiency Syndrome patients with central nervous system toxoplasmosis have a frequent association with ocular toxoplasmosis. Although the incidence of opportunistic infections has decreased since the introduction of recent antiretroviral therapeutic strategies ocular toxoplasmosis continues to be frequent in patients with cen.ral nervous system toxoplasmosis.