Toxoplasmosis in HIV/AIDS Patients: A Current Situation

Background: To determine the seroprevalence of toxoplasmosis among HIV/AIDS patients, also to determine the frequency distribution and the course of toxoplasmic encephalitis (TE) among AIDS patients. Methods: We retrospectively reviewed 505 HIV/AIDS patients who attended in the Hospital Kuala Lumpur from the period of January 2001 to December 2002. Results: The seroprevalence of toxoplasmosis among 505 HIV/AIDS patients was 44.8% (95% CI: 42.64-51.76) being 47.4% and 44.4% of Toxoplasma seropositivity detected in patients with and without TE respectively (p<0.05). Majority of patients with and without TE were in the age group of 25-34 years (44% vs 39%), males (86% vs 76%), Chinese (49% vs 53%), but was not statistically significant. The significant differences were noted in marital status, occupation, and present address between both groups. The heterosexual was the most frequent risk behavior to HIV infection being 51% (TE) and 59% (without TE). Only 6.5% and 0.7% of them later had TE after receiving primary chemoprophylaxis and antiretroviral therapy including HAART respectively (p<0.05). Our study showed that 11.3% of them were diagnosed as AIDS-related TE. The most common clinical manifestation was headache (56%) and the CT scan findings showed most lesions to be multiple (96.4%), hypodense (66.7%), and in parietal region (39.3%). 47.4% of them had chronic Toxoplasma infection as evidenced by seropositivity for anti-Toxoplasma (IgG) antibodies. At the time of diagnosis, the range of CD4 cell count was from 0-239 with a median of 25 cells/cumm. Those who developed TE had significantly showed CD4 count of less than 100 cells/cumm (p<0.05). Clinical outcomes revealed that among those who survived, 36.8%, 28.1% and 3.5% of patients had completed treatment, transferred out, and lost to follow up respectively. Unfortunately, 31.6% of the cases were officially pronounced dead. Overall, 12.3% of them were detected as recurrent TE in this study. Conclusion: The effectiveness of HAART therapy seems to be a promising agent in lowering the incidence of toxoplasmic encephalitis in this particular moment.