Cerebral toxoplasmosis, or toxoplasmic meningoencephalitis (TE), was one of the first opportunistic infections to be described in patients infected with human immunodeficiency virus (HIV). Treatment of TE has been relatively successful in comparison to other opportunistic infections. Prior to the introduction of highly active antiretroviral therapy (HAART), a median survival of over a year was reported for patients who could tolerate the toxicity of TE treatment. HAART is becoming increasingly widely available in sub-Saharan Africa, where the majority of HIV-infected patients live. Many patients in Africa are diagnosed with HIV only after developing opportunistic infections such as TE. Hence, the optimal management of opportunistic infections such as TE is important if the benefits of subsequently initiating HAART are to be seen. The purpose of this review is to determine the most effective therapy for TE in HIV-infected adults. Different treatment regimens have been compared with regard to clinical and radiological response, mortality, morbidity, and serious adverse events. Three trials were found to meet the inclusion criteria for this review. Two trials compared pyrimethamine plus sulfadiazine (P+S) with pyrimethamine plus clindamycin (P+C). One trial compared P+S with trimethoprim-sulfamethoxazole (TMP-SMX)
The available evidence fails to identify any one superior regimen for the treatment of TE. The choice of therapy will often be directed by available therapy. Given the current evidence, TMP-SMX appears to be an effective alternative therapy for TE in resource-poor settings where P+S are not available.