HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

Abstract

Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.

Plasma extracellular microRNAs are related to AIDS/cerebral toxoplasmosis co‐infection

“…2,7,8 Cerebral toxoplasmosis is fatal if untreated and a major cause of death in HIV-infected patients from low-and middle-income countries. [7][8][9] Cellular response is totally altered in HIV-infected patients. Th1/ Th2 imbalance due to HIV and the decrease in CD4 T cells (CD4 T-lymphocyte counts below 100 cells/µL) lead to reactivation of latent toxoplasmosis due to a fail of antiparasitic CD4 T-cell response.…”

“…Thus, more effective strategies are required for differential diagnosis. 7,8 For this propose, studies have been shown that microRNAs (miRNA, miR) play an important role in regulating gene expression in eukaryotic cells.…”

Serum IgG Anti-Toxoplasma gondii Antibody Concentrations Do Not Correlate Nested PCR Results in Blood Donors

“…The infection by Toxoplasma gondii is frequent around the world and its prevalence range from <30% to more than 60% (Pappas et al, 2009;Dubey et al, 2012;Wallon and Peyron, 2018;Greigert et al, 2019). Different clinical forms of toxoplasmosis resulting from the infection by this Apicomplexan parasite arises and drawn attention especially for pregnant women, newborns and other immunosuppressed patients (Robert-Gangneux and Dardé, 2012;Neu et al, 2015;Rostami et al, 2019;Vidal, 2019).…”

Cerebral toxoplasmosis and alcohol abuse in AIDS: dementia with multiple etiologies

“…2 HIV+ patients may also present brain damage caused by opportunistic diseases developed due to their immune-compromised status, such as cerebral toxoplasmosis (CT). [6][7][8] CT is a possible complication of Toxoplasma gondii infection, a common protozoa spread worldwide. About a third of the world's population is possibly infected with T. gondii, 8 with 80% of those as asymptomatic carriers.…”

“…7 Given the variety of possible symptoms, diagnosis of CT requires confirmation through histological and laboratorial means. 7 CT patients may show long-lasting cognitive impairment due to brain abscesses, including deficits to the executive functions, lower processing speed and language. 7,9 Another contributing factor to neurocognitive impairment on HIV+ patients worldwide is alcohol abuse.…”