Efficacy of trimethoprim-sulfamethoxazole in the treatment of cerebral toxoplasmosis in Aids patients

• Autor(a) principal: Otilia Rabenschlag Pellegrino, Daniela
• Data de Publicação: 2022
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: BEPA. Boletim epidemiológico paulista (Online)
• Texto Completo: https://periodicos.saude.sp.gov.br/BEPA182/article/view/37659

Cerebral toxoplasmosis (CT) continues to cause high morbimortality in developingcountries. The association of sulfadiazine and pyrimetamine (PS) is considered themainstay therapy, however, it has several disadvantages: toxicity, cost, burden of pills,low availability and the lack of a parenteral formulation. Prospective, open, single-armclinical trial to evaluate the efficacy and safety of trimethoprim- sulfamethoxazole (TMPSMX) in the treatment of CT in AIDS patients. Eligible AIDS patients had presumptiveCT, were more than 18 years old, no known allergy to the study drugs, and had noconcomitant infection of the central nervous system. Patients received TMP 10 mg/kg/day plus SMX 50 mg/kg/day BID, given orally or intravenously. Clinical and laboratoryevaluation were performed at study entry and weekly thereafter. Computed tomographyscans were performed at study entry and after 2 weeks of treatment. Clinical response wasdefined as resolution of at least 50% of neurological symptoms similarly; radiologicalresponse consisted in more than 50% decrease in number and size of initial lesions. Fortysix patients were included (23 males, median age 35) Median of CD4 cell count was 74cells/mm³. The main symptoms were headache, hemiparesis and altered mental status.First time of presumptive CT was reported in 33 (72%) patients and for 21% CT was thedefining aids condition. After two weeks of treatment, clinical and radiological responseoccurred in 39 (85%) patients. Overall, TMP-SMX was safe, 5 (11%) patients had adverseevents; 3 (6%) patients presented a Grade 1-2 skin rash, 1(2%) patient a clinical adverseevent grade 2 and 1 (2%) patient a laboratory abnormality grade 3. During a twelve-weekfollow up, a high relapse rate (22%) was observed and was associated to non-adherence,TMP-SMX was used to treat all relapses and was effective in 90% of patients. Mortalitywas 2% at 4 weeks and 9% at 12 weeks and overall mortality was 11%. In this study,TMP-SMX was effective and well tolerated in AIDS patients with CT