A systematic review of the relative efficacy and toxicity of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimephoprim-sulfamethaxozole a real option?

5.00
Hdl Handle:
http://hdl.handle.net/10757/579779
Title:
A systematic review of the relative efficacy and toxicity of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimephoprim-sulfamethaxozole a real option?
Authors:
Thota, P.; Deshpande, A.; Pellegrino, D.; Pasupuleti, V.; Benites Zapata, V.; Vidal, J.; Hernández, Adrian V. ( 0000-0002-9999-4003 )
Publisher:
IDWeek
Issue Date:
15-Oct-2015
URI:
http://hdl.handle.net/10757/579779
Additional Links:
https://idsa.confex.com/idsa/2015/webprogram/Paper53219.html
Type:
info:eu-repo/semantics/conferenceObject
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Description:
Background: Pyrimethamine and sulfadiazine (P-S) combination is effective and considered the mainstay therapy for cerebral toxoplasmosis (CT). Alternative treatment regimens are available, but their relative efficacy and tolerability are not well known. Particularly, trimephoprim-sulfamethaxozole (TMP-SMX) shows potential advantages (i.e., tolerability, posology, parenteral formulation, cost, and accessibility) but its use is infrequent when P-S is available. Methods: We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies comparing different regimens for the treatment of HIV-associated CT. 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). Treatment with P-S has the same or better clinical efficacy than P-C or TMP-SMX in terms of partial or complete response clinical response (P-C vs P-S: RR 0.87, 95%CI 0.70-1.08; TMP-SMX vs P-S: RR 0.97, 95%CI 0.78-1.21) and radiological response (P-C vs P-S: RR 0.92, 95%CI 0.82-1.03). Safety profile in terms of skin rash (P-C vs P-S: RR 0.81, 95%CI 0.56-1.17; TMP-SMX vs P-S: RR 0.17, 95%CI 0.02-1.29), liver impairment (P-C vs P-S: RR 0.48, 95%CI 0.24-0.97) and drug discontinuation due to adverse events (P-C vs P-S: RR 0.32, 95%CI 0.07-1.47) were worse with P-S regimen. Conclusion: The available evidence fails to identify any one superior regimen for the treatment of CT. However, P-S regimen has worse safety profile than P-C or TMP-SMX. Although current evidence does not allow a definitive recommendation, use of TMP-SMX for treatment of HIV-associated CT is consistent with the available data. More large studies comparing alternative therapies are needed.; IDWeek, Evento que se llevó a cabo del 7 -11 de Octubre de 2015, en la ciudad de San Diego, CA, EE.UU. Evento Sesión HIV: Other Opportunistic Infections in HIV. Saturday, October 10, 2015. Room: Poster Hall
Keywords:
Cerebral toxoplasmosis; Trimephoprim-sulfamethaxozole

Full metadata record

DC FieldValue Language
dc.contributor.authorThota, P.es_PE
dc.contributor.authorDeshpande, A.es_PE
dc.contributor.authorPellegrino, D.es_PE
dc.contributor.authorPasupuleti, V.es_PE
dc.contributor.authorBenites Zapata, V.es_PE
dc.contributor.authorVidal, J.es_PE
dc.contributor.authorHernández, Adrian V.es_PE
dc.creatorUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.date.accessioned2015-10-15T17:25:00Zes_PE
dc.date.available2015-10-15T17:25:00Zes_PE
dc.date.issued2015-10-15es_PE
dc.identifier.urihttp://hdl.handle.net/10757/579779es_PE
dc.descriptionBackground: Pyrimethamine and sulfadiazine (P-S) combination is effective and considered the mainstay therapy for cerebral toxoplasmosis (CT). Alternative treatment regimens are available, but their relative efficacy and tolerability are not well known. Particularly, trimephoprim-sulfamethaxozole (TMP-SMX) shows potential advantages (i.e., tolerability, posology, parenteral formulation, cost, and accessibility) but its use is infrequent when P-S is available. Methods: We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies comparing different regimens for the treatment of HIV-associated CT. 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). Treatment with P-S has the same or better clinical efficacy than P-C or TMP-SMX in terms of partial or complete response clinical response (P-C vs P-S: RR 0.87, 95%CI 0.70-1.08; TMP-SMX vs P-S: RR 0.97, 95%CI 0.78-1.21) and radiological response (P-C vs P-S: RR 0.92, 95%CI 0.82-1.03). Safety profile in terms of skin rash (P-C vs P-S: RR 0.81, 95%CI 0.56-1.17; TMP-SMX vs P-S: RR 0.17, 95%CI 0.02-1.29), liver impairment (P-C vs P-S: RR 0.48, 95%CI 0.24-0.97) and drug discontinuation due to adverse events (P-C vs P-S: RR 0.32, 95%CI 0.07-1.47) were worse with P-S regimen. Conclusion: The available evidence fails to identify any one superior regimen for the treatment of CT. However, P-S regimen has worse safety profile than P-C or TMP-SMX. Although current evidence does not allow a definitive recommendation, use of TMP-SMX for treatment of HIV-associated CT is consistent with the available data. More large studies comparing alternative therapies are needed.es_PE
dc.descriptionIDWeek, Evento que se llevó a cabo del 7 -11 de Octubre de 2015, en la ciudad de San Diego, CA, EE.UU. Evento Sesión HIV: Other Opportunistic Infections in HIV. Saturday, October 10, 2015. Room: Poster Halles_PE
dc.formatapplication/htmles_PE
dc.language.isoenges_PE
dc.publisherIDWeekes_PE
dc.relation.urlhttps://idsa.confex.com/idsa/2015/webprogram/Paper53219.htmles_PE
dc.rightsinfo:eu-repo/semantics/openAccesses_PE
dc.sourceUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.sourceRepositorio Académico - UPCes_PE
dc.subjectCerebral toxoplasmosises_PE
dc.subjectTrimephoprim-sulfamethaxozolees_PE
dc.titleA systematic review of the relative efficacy and toxicity of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimephoprim-sulfamethaxozole a real option?es_PE
dc.typeinfo:eu-repo/semantics/conferenceObjectes_PE
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