Vidal José Ernesto
1 Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
2 Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
J Int Assoc Provid AIDS Care. 2019 Jan-Dec;18:2325958219867315. doi: 10.1177/2325958219867315.
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.
脑弓形虫病是人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）患者中扩展性脑病变最常见的病因，并且持续导致高发病率和死亡率。最常见的特征是局灶性亚急性神经功能缺损以及基底节区环形强化脑病变，但临床和神经影像学表现范围广泛。尽早开始抗弓形虫治疗是HIV/AIDS患者扩展性脑病变诊断方法的一个重要特征。基于乙胺嘧啶的治疗方案和复方磺胺甲恶唑（TMP-SMX）似乎疗效相似，但TMP-SMX显示出潜在的实际优势。免疫重建炎症综合征在脑弓形虫病中并不常见，而且我们现在有更有效、安全且友好的联合抗逆转录病毒治疗（cART）方案。由于这两个变量，cART可在抗弓形虫治疗开始后2周内启动。在此，我们将回顾HIV相关脑弓形虫病的流行病学、诊断和治疗的历史及当前概念。
