Therapeutic approaches for AIDS-related toxoplasmosis

OBJECTIVE: To summarize current knowledge of prophylaxis and treatment of AIDS-related toxoplasmosis.

DATA SOURCES: A MEDLINE search (1985-1994) was used to identify pertinent literature, including reviews.

STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion.

DATA SYNTHESIS: Trimethoprim/sulfamethoxazole (TMP/SMX) appears to be useful for prophylaxis against toxoplasmosis in patients with AIDS. The most effective TMP/SMX dose for prevention of toxoplasmosis needs to be determined. Dapsone in combination with pyrimethamine therapy may be an effective alternative for toxoplasmosis prophylaxis. The most effective regimen for the treatment of AIDS-related toxoplasmosis is the combination therapy of pyrimethamine/sulfadiazine. In patients who cannot tolerate sulfadiazine therapy because of adverse effects or allergy, pyrimethamine with clindamycin therapy may be considered as a second-line alternative. Lifelong suppressive therapy is required after either treatment regimen to prevent relapse. Other newer agents such as azithromycin, clarithromycin, atovaquone, or timetrexate-leucovorin need further studies to confirm their true effectiveness in the treatment of toxoplasmosis.

CONCLUSIONS: TMP/SMX remains a useful agent in prophylaxis against toxoplasmosis. Pyrimethamine/sulfadiazine is the most effective combination in the treatment of acute toxoplasmosis.