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  1. Article ; Online: Heterologous COVID-19 vaccination as a strategy to accelerate mass immunization.

    Klastrup, Vibeke / Stærke, Nina Breinholt / Søgaard, Ole Schmeltz

    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

    2022  Volume 28, Issue 10, Page(s) 1316–1318

    MeSH term(s) Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19/prevention & control ; COVID-19 Vaccines ; Humans ; Immunization, Secondary ; Mass Vaccination ; Vaccination
    Chemical Substances Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 Vaccines
    Language English
    Publishing date 2022-07-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 1328418-6
    ISSN 1469-0691 ; 1470-9465 ; 1198-743X
    ISSN (online) 1469-0691
    ISSN 1470-9465 ; 1198-743X
    DOI 10.1016/j.cmi.2022.06.032
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  2. Article ; Online: A cohort study of the long-term outcome of latent tuberculosis infection among socially marginalized people in a low-incidence country.

    Stærke, Nina Breinholt / Martinsen, Janne Tegder / Jensen, Torben Tranborg / Weinreich, Ulla Møller / Hilberg, Ole / Folkvardsen, Dorte Bek / Wejse, Christian / Fløe, Andreas

    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

    2022  Volume 124 Suppl 1, Page(s) S56–S62

    Abstract: Background: Tuberculosis (TB) prevalence is high among socially marginalized citizens in Denmark, and management of latent TB infection (LTBI) may be part of preventing new cases. Patients with LTBI are offered either preventive treatment (TPT) or ... ...

    Abstract Background: Tuberculosis (TB) prevalence is high among socially marginalized citizens in Denmark, and management of latent TB infection (LTBI) may be part of preventing new cases. Patients with LTBI are offered either preventive treatment (TPT) or follow-up chest x-rays, but knowledge about the long-term outcome in terms of active TB is sparse.
    Methods: We performed a retrospective cohort study investigating the long-term outcomes for socially marginalized citizens who were diagnosed with LTBI or who had a positive interferon-gamma release assay (IGRA) but were lost to follow-up. Information on TB examinations, diagnostics, and treatment along with data on death were gathered from medical records from the date of positive IGRA to February 1, 2021.
    Results: We identified 119 patients with LTBI, 18 of which (15.1%) were diagnosed with TB during the follow-up period (mean, 4.5 years). TPT was completed by 36.1% and the TB incidence rate ratio of those completing TPT to those who did not was 0.78 (confidence interval, 0.25-2.17; P =.6). Of the patients with TB, 16 of 18 achieved treatment success.
    Conclusion: High rates of TB development are found among socially marginalized citizens with LTBI. Overall incidence of TB was not significantly reduced by administration of TPT, although TB did not develop in the first 2 years following TPT.
    Language English
    Publishing date 2022-02-26
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 1331197-9
    ISSN 1878-3511 ; 1201-9712
    ISSN (online) 1878-3511
    ISSN 1201-9712
    DOI 10.1016/j.ijid.2022.02.033
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  3. Article ; Online: The cascade of care in tuberculosis infection screening and management in newly arrived refugees in Aarhus, Denmark.

    Stærke, Nina Breinholt / Fløe, Andreas / Nielsen, Mie Fryd / Holm, Mette / Holm, Emma / Hilberg, Ole / Wejse, Christian / Hvass, Anne Mette Fløe

    Travel medicine and infectious disease

    2022  Volume 49, Page(s) 102388

    Abstract: Background: Screening for tuberculosis (TB) disease and infection is often a part of health screening programs offered to refugees, but the yield of screening varies and losses along the steps from screening to treatment completion was reported.: ... ...

    Abstract Background: Screening for tuberculosis (TB) disease and infection is often a part of health screening programs offered to refugees, but the yield of screening varies and losses along the steps from screening to treatment completion was reported.
    Methods: A retrospective cohort study was performed investigating a newly arrived refugee population offered a systematic refugee health assessment in Aarhus, Denmark. Data was collected on screening, referral, diagnosis and treatment for TB disease and infection.
    Results: Among both adults and children IGRA positivity was associated with origin in a high TB incidence country and increasing age. The number needed to screen (NNS) to find one case of TB infection was 7 among adult refugees and 19 among children, while NNS for TB disease was 266 and 164 respectively. The proportion of the eligible population with a valid result was 78.1% for adults and 71.3% for children, while 43.1% and 50% of adults and children with presumed TB infection completed preventive treatment.
    Discussion: Screening for TB disease and infection among refugees in Aarhus had a high yield in terms of diagnosis, however significant losses were seen during screening, follow-up and preventive treatment completion.
    MeSH term(s) Adult ; Child ; Denmark/epidemiology ; Humans ; Interferon-gamma Release Tests ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/epidemiology ; Mass Screening ; Refugees ; Retrospective Studies ; Tuberculin Test ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology
    Language English
    Publishing date 2022-06-23
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2170891-5
    ISSN 1873-0442 ; 1477-8939
    ISSN (online) 1873-0442
    ISSN 1477-8939
    DOI 10.1016/j.tmaid.2022.102388
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  4. Article: Lot-to-lot consistency, safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in healthy adults aged ≥50 years: A randomized phase 3 trial (PNEU-TRUE)

    Simon, Jakub K. / Staerke, Nina Breinholt / Hemming-Harlo, Maria / Layle, Stacey / Dagan, Ron / Shekar, Tulin / Pedley, Alison / Jumes, Patricia / Tamms, Gretchen / Sterling, Tina / Musey, Luwy / Buchwald, Ulrike K.

    Vaccine. 2022 Feb. 23, v. 40, no. 9

    2022  

    Abstract: Older adults are at risk of pneumococcal disease and associated morbidity and mortality. This phase 3 study (V114-020) assessed lot-to-lot consistency across safety and immunogenicity outcomes for V114, a 15-valent pneumococcal conjugate vaccine (PCV), ... ...

    Institution for the V114-020 PNEU-TRUE study group
    Abstract Older adults are at risk of pneumococcal disease and associated morbidity and mortality. This phase 3 study (V114-020) assessed lot-to-lot consistency across safety and immunogenicity outcomes for V114, a 15-valent pneumococcal conjugate vaccine (PCV), in healthy adults aged ≥ 50 years. Adults were randomized in a 3:3:3:1 ratio to receive a single dose of one of three lots of V114 or 13-valent PCV (PCV13), stratified by age (50–64 years, 65–74 years, and ≥ 75 years). Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were evaluated at baseline (Day 1) and 30 days post-vaccination. Non-serious and serious adverse events (AEs) were evaluated post-vaccination through 14 days and Month 6, respectively. Of 2340 participants enrolled, 2282 (97.5%) completed the study. Proportions of participants experiencing ≥ 1 AE were 81.0%, 77.4%, and 78.0% for V114 lots 1, 2, and 3, respectively. Comparison of V114 combined lots with PCV13 showed that proportions of participants experiencing AEs, solicited AEs, and serious AEs were comparable for both vaccines, with the exception of injection-site pain (more frequently reported with V114). OPA geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) at 30 days post-vaccination were comparable across V114 lots, and all lots met predefined equivalence criteria for all 15 vaccine serotypes (lower and upper limits of the 95% confidence intervals of serotype-specific OPA GMT ratios for all possible pairwise comparisons across the three lots were within the equivalence margin of 0.5–2.0). Serotype-specific OPA GMTs and IgG GMCs were comparable in the V114 combined lots and PCV13 groups for the 13 shared serotypes and higher in the V114 group for serotypes unique to V114 (22F and 33F). V114 is well tolerated with a consistent safety profile and immune response across manufacturing lots. Clinical trials registration: NCT03950856 (www.clinicaltrials.gov); 2018-004266-33 (EudraCT).
    Keywords Streptococcus pneumoniae ; immune response ; immunogenicity ; immunoglobulin G ; injection site ; morbidity ; mortality ; pain ; risk ; serotypes ; vaccines
    Language English
    Dates of publication 2022-0223
    Size p. 1342-1351.
    Publishing place Elsevier Ltd
    Document type Article
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2021.12.067
    Database NAL-Catalogue (AGRICOLA)

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  5. Article ; Online: Lot-to-lot consistency, safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in healthy adults aged ≥50 years: A randomized phase 3 trial (PNEU-TRUE).

    Simon, Jakub K / Staerke, Nina Breinholt / Hemming-Harlo, Maria / Layle, Stacey / Dagan, Ron / Shekar, Tulin / Pedley, Alison / Jumes, Patricia / Tamms, Gretchen / Sterling, Tina / Musey, Luwy / Buchwald, Ulrike K

    Vaccine

    2022  Volume 40, Issue 9, Page(s) 1342–1351

    Abstract: Background: Older adults are at risk of pneumococcal disease and associated morbidity and mortality. This phase 3 study (V114-020) assessed lot-to-lot consistency across safety and immunogenicity outcomes for V114, a 15-valent pneumococcal conjugate ... ...

    Abstract Background: Older adults are at risk of pneumococcal disease and associated morbidity and mortality. This phase 3 study (V114-020) assessed lot-to-lot consistency across safety and immunogenicity outcomes for V114, a 15-valent pneumococcal conjugate vaccine (PCV), in healthy adults aged ≥ 50 years.
    Methods: Adults were randomized in a 3:3:3:1 ratio to receive a single dose of one of three lots of V114 or 13-valent PCV (PCV13), stratified by age (50-64 years, 65-74 years, and ≥ 75 years). Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were evaluated at baseline (Day 1) and 30 days post-vaccination. Non-serious and serious adverse events (AEs) were evaluated post-vaccination through 14 days and Month 6, respectively.
    Results: Of 2340 participants enrolled, 2282 (97.5%) completed the study. Proportions of participants experiencing ≥ 1 AE were 81.0%, 77.4%, and 78.0% for V114 lots 1, 2, and 3, respectively. Comparison of V114 combined lots with PCV13 showed that proportions of participants experiencing AEs, solicited AEs, and serious AEs were comparable for both vaccines, with the exception of injection-site pain (more frequently reported with V114). OPA geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) at 30 days post-vaccination were comparable across V114 lots, and all lots met predefined equivalence criteria for all 15 vaccine serotypes (lower and upper limits of the 95% confidence intervals of serotype-specific OPA GMT ratios for all possible pairwise comparisons across the three lots were within the equivalence margin of 0.5-2.0). Serotype-specific OPA GMTs and IgG GMCs were comparable in the V114 combined lots and PCV13 groups for the 13 shared serotypes and higher in the V114 group for serotypes unique to V114 (22F and 33F).
    Conclusions: V114 is well tolerated with a consistent safety profile and immune response across manufacturing lots.
    Clinical trials registration: NCT03950856 (www.clinicaltrials.gov); 2018-004266-33 (EudraCT).
    MeSH term(s) Aged ; Antibodies, Bacterial ; Humans ; Immunogenicity, Vaccine ; Middle Aged ; Pneumococcal Infections/drug therapy ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines ; Serogroup ; Vaccination ; Vaccines, Conjugate
    Chemical Substances Antibodies, Bacterial ; Pneumococcal Vaccines ; Vaccines, Conjugate
    Language English
    Publishing date 2022-01-14
    Publishing country Netherlands
    Document type Clinical Trial, Phase III ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2021.12.067
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  6. Article ; Online: Tuberculosis incidence and mortality in people living with human immunodeficiency virus: a Danish nationwide cohort study.

    Martin-Iguacel, Raquel / Llibre, Josep M / Pedersen, Court / Obel, Niels / Stærke, Nina Breinholt / Åhsberg, Johanna / Ørsted, Iben / Holden, Inge / Kronborg, Gitte / Mohey, Rajesh / Rasmussen, Line Dahlerup / Johansen, Isik Somuncu

    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

    2021  Volume 28, Issue 4, Page(s) 570–579

    Abstract: Objectives: To explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH).: Methods: In this nationwide, population-based cohort study we included all adult PLWH from ... ...

    Abstract Objectives: To explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH).
    Methods: In this nationwide, population-based cohort study we included all adult PLWH from the Danish HIV Cohort Study (1995-2017) without previous TB. We estimated TB incidence rate (IR), all-cause mortality rate (MR), associated risk and prognostic factors using Poisson regression.
    Results: Among 6982 PLWH (73 596 person-years (PY)), we observed 217 TB events (IR 2.9/1000 PY, 95% CI 2.6-3.4: IR 6.7, 95% CI 5.7-7.9 among migrants and IR 1.4, 95% CI 1.1-1.7 among Danish-born individuals; p < 0.001). The IR of concomitant HIV/TB remained high and unchanged over time. The IR of TB diagnosed >3 months after HIV diagnosis declined with calendar time, longer time from HIV diagnosis, and CD4 cell recovery. Independent TB risk factors were African/Asian/Greenland origin (adjusted incidence rate ratio (aIRR) 5.2, 95% CI 3.5-7.6, aIRR 6.5, 95% CI 4.2-10.0, aIRR 7.0, 95% CI 3.4-14.6, respectively), illicit drug use (aIRR 6.9, 95% CI 4.2-11.2), CD4 <200 cells/μL (aIRR 2.7, 95% CI 2.0-3.6) and not receiving antiretroviral therapy (aIRR 3.7, 95% CI 2.5-5.3). Fifty-five patients died (MR 27.9/1000 PY, 95% CI 21.4-36.3), with no improvement in mortality over time. Mortality prognostic factors were Danish-origin (adjusted mortality rate ratio (aMRR) 2.3, 95% CI 1.3-4.3), social burden (aMRR 3.9, 95% CI 2.2-7.0), CD4 <100 cells/μL at TB diagnosis (aMRR 2.6, 95% CI 1.3-4.9), TB diagnosed >3 months after HIV versus concomitant diagnosis (aMRR 4.3, 95% CI 2.2-8.7) and disseminated TB (aMRR 3.3, 95% CI 1.1-9.9).
    Conclusion: Late HIV presentation with concomitant TB remains a challenge. Declining TB rates in PLWH were observed over time and with CD4 recovery, highlighting the importance of early and successful antiretroviral therapy. However, MR remained high. Our findings highlight the importance of HIV and TB screening strategies and treatment of latent TB in high-risk groups.
    MeSH term(s) Adult ; CD4 Lymphocyte Count ; Cohort Studies ; Denmark/epidemiology ; HIV ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Incidence ; Risk Factors ; Tuberculosis/complications ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology
    Language English
    Publishing date 2021-08-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 1328418-6
    ISSN 1469-0691 ; 1470-9465 ; 1198-743X
    ISSN (online) 1469-0691
    ISSN 1470-9465 ; 1198-743X
    DOI 10.1016/j.cmi.2021.07.036
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  7. Article ; Online: High yield from repeated testing for tuberculosis among high-risk citizens in Denmark.

    Staerke, Nina Breinholt / Smidt-Hansen, Torben / Oldenborg, Leni / Jensen, Torben Tranborg / Weinreich, Ulla Møller / Shakar, Shakil / Wejse, Christian / Hilberg, Ole / Fløe, Andreas

    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

    2020  Volume 102, Page(s) 352–356

    Abstract: Background: Screening for TB (tuberculosis) among socially marginalized citizens has been implemented in many urban areas in countries with a low incidence of TB, including Denmark. This study aims to describe the findings of the screening programs for ... ...

    Abstract Background: Screening for TB (tuberculosis) among socially marginalized citizens has been implemented in many urban areas in countries with a low incidence of TB, including Denmark. This study aims to describe the findings of the screening programs for TB and latent tuberculosis (LTBI) used in the western part of Denmark in the period 2014-2019.
    Methods: Data was collected retrospectively on test results from interferon-gamma release assays (IGRA), spot sputum tests and chest X-rays performed as part of TB and LTBI screening among 1024 socially marginalized citizens in urban areas of western Denmark in 2014-2019.
    Results: The overall TB incidence was 2148/100.000 and number needed to screen to find one TB case was 39. The incidence of LTBI in the group screened using IGRA was 17.500/100.000. TB incidence when using spot sputum test was 2.5, while TB incidence when using IGRA as the primary screening test was 2.7. In total, 38.9% of TB diagnoses were obtained after the second or third round of screening.
    Conclusion: We demonstrated a high incidence of TB and LTBI among socially marginalized citizens in Denmark. Screening with spot sputum testing and IGRA generated comparable results in diagnosing TB in this setting.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Denmark/epidemiology ; Female ; Humans ; Incidence ; Interferon-gamma Release Tests/methods ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/diagnostic imaging ; Latent Tuberculosis/epidemiology ; Male ; Mass Screening ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Tuberculin Test ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology ; Young Adult
    Language English
    Publishing date 2020-10-31
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 1331197-9
    ISSN 1878-3511 ; 1201-9712
    ISSN (online) 1878-3511
    ISSN 1201-9712
    DOI 10.1016/j.ijid.2020.10.076
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  8. Article: Incidence, clinical presentation, and outcome of HIV-1-associated cryptococcal meningitis during the highly active antiretroviral therapy era: a nationwide cohort study.

    Touma, Madeleine / Rasmussen, Line D / Martin-Iguacel, Raquel / Engsig, Frederik Neess / Stærke, Nina Breinholt / Stærkind, Mette / Obel, Niels / Ahlström, Magnus Glindvad

    Clinical epidemiology

    2017  Volume 9, Page(s) 385–392

    Abstract: Background: Human immunodeficiency virus (HIV) infection with advanced immunosuppression predisposes to cryptococcal meningitis (CM). We describe the incidence, clinical presentation, and outcome of CM in HIV-infected individuals during the highly ... ...

    Abstract Background: Human immunodeficiency virus (HIV) infection with advanced immunosuppression predisposes to cryptococcal meningitis (CM). We describe the incidence, clinical presentation, and outcome of CM in HIV-infected individuals during the highly active antiretroviral therapy (HAART) era.
    Methods: A nationwide, population-based cohort of HIV-infected individuals was used to estimate incidence and mortality of CM including risk factors. A description of neurological symptoms of CM at presentation and follow-up in the study period 1995-2014 was included in this study.
    Results: Among 6,351 HIV-infected individuals, 40 were diagnosed with CM. The incidence rates were 3.7, 1.8, and 0.3 per 1000 person-years at risk in 1995-1996, 1997-1999, and 2000-2014, respectively. Initiation of HAART was associated with decreased risk of acquiring CM [incidence rate ratio (IRR), 0.1 (95% CI, 0.05-0.22)]. African origin was associated with increased risk of CM [IRR, 2.05 (95% CI, 1.00-4.20)]. The main signs and symptoms at presentation were headache, cognitive deficits, fever, neck stiffness, nausea, and vomiting. All individuals diagnosed with CM had a CD4
    Conclusion: The incidence of HIV-associated CM has decreased substantially after the introduction of HAART. To further decrease CM incidence and associated mortality, early HIV diagnosis and HAART initiation seems crucial.
    Language English
    Publishing date 2017-07-21
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2494772-6
    ISSN 1179-1349
    ISSN 1179-1349
    DOI 10.2147/CLEP.S135309
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  9. Article ; Online: Impact of age and comorbidities on SARS-CoV-2 vaccine-induced T cell immunity.

    Dietz, Lisa Loksø / Juhl, Anna Karina / Søgaard, Ole Schmeltz / Reekie, Joanne / Nielsen, Henrik / Johansen, Isik Somuncu / Benfield, Thomas / Wiese, Lothar / Stærke, Nina Breinholt / Jensen, Tomas Østergaard / Jakobsen, Stine Finne / Olesen, Rikke / Iversen, Kasper / Fogh, Kamille / Bodilsen, Jacob / Petersen, Kristine Toft / Larsen, Lykke / Madsen, Lone Wulff / Lindvig, Susan Olaf /
    Holden, Inge Kristine / Raben, Dorthe / Andersen, Sidsel Dahl / Hvidt, Astrid Korning / Andreasen, Signe Rode / Baerends, Eva Anna Marianne / Lundgren, Jens / Østergaard, Lars / Tolstrup, Martin

    Communications medicine

    2023  Volume 3, Issue 1, Page(s) 58

    Abstract: Background: Older age and chronic disease are important risk factors for developing severe COVID-19. At population level, vaccine-induced immunity substantially reduces the risk of severe COVID-19 disease and hospitalization. However, the relative ... ...

    Abstract Background: Older age and chronic disease are important risk factors for developing severe COVID-19. At population level, vaccine-induced immunity substantially reduces the risk of severe COVID-19 disease and hospitalization. However, the relative impact of humoral and cellular immunity on protection from breakthrough infection and severe disease is not fully understood.
    Methods: In a study cohort of 655 primarily older study participants (median of 63 years (IQR: 51-72)), we determined serum levels of Spike IgG antibodies using a Multiantigen Serological Assay and quantified the frequency of SARS-CoV-2 Spike-specific CD4 + and CD8 + T cells using activation induced marker assay. This enabled characterization of suboptimal vaccine-induced cellular immunity. The risk factors of being a cellular hypo responder were assessed using logistic regression. Further follow-up of study participants allowed for an evaluation of the impact of T cell immunity on breakthrough infections.
    Results: We show reduced serological immunity and frequency of CD4 + Spike-specific T cells in the oldest age group (≥75 years) and higher Charlson Comorbidity Index (CCI) categories. Male sex, age group ≥75 years, and CCI > 0 is associated with an increased likelihood of being a cellular hypo-responder while vaccine type is a significant risk factor. Assessing breakthrough infections, no protective effect of T cell immunity is identified.
    Conclusions: SARS-CoV-2 Spike-specific immune responses in both the cellular and serological compartment of the adaptive immune system increase with each vaccine dose and are progressively lower with older age and higher prevalence of comorbidities. The findings contribute to the understanding of the vaccine response in individuals with increased risk of severe COVID-19 disease and hospitalization.
    Language English
    Publishing date 2023-04-24
    Publishing country England
    Document type Journal Article
    ISSN 2730-664X
    ISSN (online) 2730-664X
    DOI 10.1038/s43856-023-00277-x
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  10. Article ; Online: Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era.

    Martin-Iguacel, Raquel / Ahlström, Magnus Glindvad / Touma, Madeleine / Engsig, Frederik Neess / Stærke, Nina Breinholt / Stærkind, Mette / Obel, Niels / Rasmussen, Line D

    The Journal of infection

    2017  Volume 75, Issue 3, Page(s) 263–273

    Abstract: Background: HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.: Methods: From the Danish HIV Cohort Study, we identified 6325 HIV-infected individuals. We assessed incidence, mortality, ... ...

    Abstract Background: HIV-associated incidence and prognosis of cerebral toxoplasmosis (CTX) is not well established during later years.
    Methods: From the Danish HIV Cohort Study, we identified 6325 HIV-infected individuals. We assessed incidence, mortality, predictive and prognostic factors of CTX during the pre-combination antiretroviral therapy (pre-cART; 1995-1996) and cART-era (1997-2014). Adjusted incidence rate ratios (aIRR), mortality rate ratios (aMRR) and 95% confidence intervals (CI) were assessed using Poisson regression analysis.
    Results: CTX IR was 1.17/1000 PYR (95% CI 0.93-1.47). We observed no change in CTX-risk in the first year after HIV-diagnosis, but a substantial reduction in mortality in the first 3 months after CTX diagnosis when comparing the cART-era to the pre-cART-era; {(aIRR: 0.79; 95% CI: 0.37-1.72) (aMRR: 0.15; 95% CI: 0.06-0.38)}. For individuals surviving the first year after HIV-diagnosis or the first 3 months after CTX-diagnosis, IRR and MRR had declined to minimal levels {(aIRR: 0.06; 95% CI: 0.03-0.10); (aMRR: 0.02; 95% CI: 0.01-0.05)}. Three years after CTX-diagnosis 30% of the patients still had neurological deficits.
    Conclusion: Although, CTX remains an important cause of morbidity and mortality in the cART-era, with high prevalence of neurological sequelae, incidence and mortality has largely declined, especially among those surviving the first year after diagnosis.
    MeSH term(s) AIDS-Related Opportunistic Infections/diagnosis ; AIDS-Related Opportunistic Infections/epidemiology ; AIDS-Related Opportunistic Infections/mortality ; AIDS-Related Opportunistic Infections/parasitology ; Adult ; Anti-HIV Agents/adverse effects ; Anti-HIV Agents/therapeutic use ; Antiretroviral Therapy, Highly Active ; Cohort Studies ; Denmark/epidemiology ; Drug Therapy, Combination ; Female ; HIV Infections/complications ; HIV Infections/drug therapy ; Humans ; Incidence ; Male ; Middle Aged ; Poisson Distribution ; Prognosis ; Risk Factors ; Toxoplasmosis, Cerebral/diagnosis ; Toxoplasmosis, Cerebral/epidemiology ; Toxoplasmosis, Cerebral/mortality ; Toxoplasmosis, Cerebral/parasitology
    Chemical Substances Anti-HIV Agents
    Language English
    Publishing date 2017-06-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 424417-5
    ISSN 1532-2742 ; 0163-4453
    ISSN (online) 1532-2742
    ISSN 0163-4453
    DOI 10.1016/j.jinf.2017.05.018
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