Neurocysticercosis and HIV Infection: what can we learn from the published literature?

OBJECTIVE: Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. METHODS: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. RESULTS: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. CONCLUSION: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

Neurocysticercosis and HIV Infection: what can we learn from the published literature? / Neurocisticercosis e infección por VIH: ¿Qué se puede aprender de la literatura reportada?

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

RESUMO Las infecciones causadas por el virus de inmunodeficiencia humana (VIH) y la larva de la Tenia solium siguen estando diseminadas en países en vías de desarrollo. Ambas patologías modifican el estado inmune y es posible que la infección por el VIH module la frecuencia y la patología de la neurocisticercosis (NCC). Objetivo: Describir los casos publicados de NCC en los pacientes VIH positivos y evaluar si las características de la NCC, incluyendo frecuencia, síntomas, presentación radiológica, respuesta a tratamiento, difieren entre los sujetos VIH positivos y VIH negativos. Métodos: Cuarenta casos con coinfección NCC/VIH fueron identificados en la literatura. Se compararon sus características clínico-radiológicas, así como su respuesta al tratamiento con diferentes series de casos históricos no pareados. Resultados: La mayoría de los pacientes NCC/VIH tenían epilepsia y múltiples parásitos vesiculares en el parénquima. Las características clínico-radiológicas de la NCC así como la evolución de los pacientes fueron similares entre pacientes VIH positivos y negativos, así como entre pacientes VIH inmunocomprometidos y no inmunocomprometidos. Conclusión: No encontramos interacciones claras entre VIH y NCC. Este resultado puede haber sido influenciado por el pequeño número de casos y la parcialidad de la información publicada. Un esfuerzo multiinstitucional, sistemático encaminado a reportar todos los casos de esta patología dual es necesario para confirmar estos resultados y esclarecer la relación entre patógenos.