Article Text

PDF
ID: 100: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RELATIVE EFFICACY AND SAFETY OF TREATMENT REGIMENS FOR HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS
  1. P Thota1,
  2. V Pasupuleti1,
  3. D Pellegrino2,
  4. VA Benites-Zapata3,
  5. A Deshpande4,
  6. JE Vidal5,
  7. AV Hernandez6
  1. 1Case Western Reserve University, Cleveland, Ohio, United States
  2. 2Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
  3. 3Universidad de San Martin de Porres, Lima, Peru
  4. 4Cleveland Clinic, Cleveland, Ohio, United States
  5. 5University of Sao Paulo, Sao Paulo, Brazil
  6. 6Universidad Peruana de Ciencias Aplicadas, Lima, Peru

Abstract

Aim The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. Pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although, trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent.

Methods Design: Systematic review and meta-analysis. We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models.

Results Nine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). In comparison to P-S, treatment with P-C or TMP-SMX had similar partial or complete clinical response (P-C: RR 0.87, 95%CI 0.70–1.08; TMP-SMX: RR 0.97, 95%CI 0.78–1.21), radiological response (P-C: RR 0.92, 95%CI 0.82–1.03), skin rash (P-C: RR 0.81, 95%CI 0.56–1.17; TMP-SMX: RR 0.17, 95%CI 0.02–1.29), gastrointestinal impairment (P-C: RR 5.16, 95%CI 0.66–40.11), and drug discontinuation due to adverse events (P-C: RR 0.32, 95%CI 0.07–1.47). Liver impairment was more frequent with P-S than P-C (P-C vs P-S: RR 0.48, 95% CI 0.24–0.97).

Conclusions The current evidence fails to identify one superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real world considerations. Larger comparative studies are needed.

  • Abdomen

Statistics from Altmetric.com

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.