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