A prospective study of 55 confirmed or presumptive cases of
cerebral toxoplasmosis in HIV positive patients in Brazil was performed to describe clinical characteristics and to identify predictive factors for clinical response to the anti-Toxoplasma treatment.
Cerebral toxoplasmosis led to the diagnosis of
HIV infection in 19 (35%) patients, whereas it was the
AIDS defining disease in 41 (75%) patients. Of these, 22 (54%) patients were previously know to be HIV-positive. At diagnosis of
cerebral toxoplasmosis, only 4 (7%) patients were on
highly active antiretroviral therapy (
HAART), and 6 (11%) were receiving primary
cerebral toxoplasmosis prophylaxis. The mean CD4+ cell count was 64.2 (+/- 69.1) cells per microliter. Forty-nine patients (78%) showed alterations consistent with
toxoplasmosis on brain computed tomography. At 6 weeks of treatment, 23 (42%) patients had complete clinical response, 25 (46%) partial response, and 7 (13%) died. Alteration of consciousness, Karnofsky score less than 70, psychomotor slowing,
hemoglobin less than 12 mg/dL, mental
confusion, Glasgow Coma Scale less than 12 were the main predictors of partial clinical response. All patients were placed on
HAART within the first 4 weeks of diagnosis of
cerebral toxoplasmosis. One year after the diagnosis, all available patients were on
HAART and
toxoplasmosis prophylaxis, and only 2 patients had relapse of
cerebral toxoplasmosis. In Brazilian patients with
AIDS,
cerebral toxoplasmosis mainly occurs as an
AIDS-defining disease, and causes significant morbidity and mortality. Signs of neurologic deterioration predict an unfavorable response to the treatment. Early start of
HAART seems to be related to better survival and less relapses.