Risk factors of cerebral toxoplasmosis in HIV patients: A systematic review

Abstract

Introduction. Cerebral toxoplasmosis is one of the diseases of the central nervous system that can occur in people with AIDS. Cerebral toxoplasmosis occupies third place among fatal diseases that can occur in people with AIDS. Prevalence of toxoplasmosis is about 25-30% of the world’s human population, and in Asia it is as high as 40%. Risk factors for developing cerebral toxoplasmosis is needed to be sought to to find out risk factors that triggers and acts as protective factors for toxoplasmosis cerebral in HIV-positive patients Methods. Two reviewers searched PubMed and Medline to identify cohort, case-control and cross-sectional studies. Two independent reviewers searched the databases, identified studies and extracted data. Inclusion and exclusion criteria were applied for the data screening. Results. Four studies were included. Two prospective cohort studies, one multicenter cohort study and one case control study. Age was not found to have a role as a risk factor. Gender was shown to have significant in one study (Male vs female OR 0.47 95% CI 0.25-0.88, p = 0.02). CD4 <100 increased the risk of toxoplasmosis by 27.94 times, while CD4 0-50 increased the risk by 10.82 times. HIV viral load > 100.000 was associated with 5.10 times higher to develop cerebral toxoplasma. Prophylaxis therapy using cotrimoxazole can reduce the risk of cerebral toxoplasmosis. Conclusion. Age, female sex, low CD4 cell count, and high HIV viral load increase the risk of cerebral toxoplasmosis, whereas ART therapy and prophylaxis with cotrimoxazole can reduce the risk.

Características clínico-epidemiológicas de pessoas vivendo com HIV e com neurotoxoplasmose na região oeste do estado do Pará, Brasil

“…Nesse sentido, Azovtseva et al 1 verificaram que indivíduos com menor tempo de uso da TARV possuem maiores probabilidades de apresentar dano cerebral grave quando comparados àqueles com um tratamento mais longo. Assim, o uso regular da TARV e o tratamento profilático da NTX podem desempenhar papel protetor nesses indivíduos e reduzir o risco de dano cerebral grave 1,26 . Além disso, ressalta-se o acompanhamento da sorologia para a toxoplasmose como um fator preventivo, visto que, na maioria dos casos, ela pode se apresentar assintomática 27 , gerando um subdiagnóstico.…”

Toxoplasma gondii, HBV, and HCV co‐infection and their correlation with CD4 cells among Iranian HIV‐positive patients

“…20 As such, the results of a recent meta-analysis revealed that the risk of cerebral toxoplasmosis increases 27.94 times in PLWH with CD4 + T cells <100/mm 3 . 21 Hepatitis B virus (HBV) and hepatitis C virus (HCV) are a major public health concern, especially among HIV infected patients. 22,23 As HIV, HBV, and HCV share similar transmission routes (e.g., sexual route, drug injection, and needle stick injury), co-infection with these viruses is more common than in the general population.…”

“… 20 As such, the results of a recent meta‐analysis revealed that the risk of cerebral toxoplasmosis increases 27.94 times in PLWH with CD4 + T cells <100/mm 3 . 21 …”

“…On the other hand, the number of CD4 + count (<200/mm 3 ) is a significant risk factor for toxoplasmosis in PLWH 20 . As such, the results of a recent meta‐analysis revealed that the risk of cerebral toxoplasmosis increases 27.94 times in PLWH with CD4 + T cells <100/mm 3 21 …”