A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?

2.50
Hdl Handle:
http://hdl.handle.net/10757/622311
Title:
A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?
Authors:
Hernandez, Adrian V. ( 0000-0002-9999-4003 ) ; Thota, P; Pellegrino, D; Pasupuleti, V; Benites-Zapata, VA; Deshpande, A; Penalva de Oliveira, AC; Vidal, JE
Citation:
A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option? 2017, 18 (2):115 HIV Medicine
Publisher:
Blackwell Publishing Ltd
Journal:
HIV Medicine
Issue Date:
Feb-2017
URI:
http://hdl.handle.net/10757/622311
DOI:
10.1111/hiv.12402
Additional Links:
http://doi.wiley.com/10.1111/hiv.12402
Abstract:
OBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The 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: We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. RESULTS: Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (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 because of 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 a 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.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/restrictedAccess
Language:
eng
Description:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Keywords:
Cerebral toxoplasmosis; HIV infection; Toxoplasmic encephalitis
ISSN:
14642662

Full metadata record

DC FieldValue Language
dc.contributor.authorHernandez, Adrian V.es
dc.contributor.authorThota, Pes
dc.contributor.authorPellegrino, Des
dc.contributor.authorPasupuleti, Ves
dc.contributor.authorBenites-Zapata, VAes
dc.contributor.authorDeshpande, Aes
dc.contributor.authorPenalva de Oliveira, ACes
dc.contributor.authorVidal, JEes
dc.date.accessioned2017-10-26T16:36:59Z-
dc.date.available2017-10-26T16:36:59Z-
dc.date.issued2017-02-
dc.identifier.citationA systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option? 2017, 18 (2):115 HIV Medicinees
dc.identifier.issn14642662-
dc.identifier.doi10.1111/hiv.12402-
dc.identifier.urihttp://hdl.handle.net/10757/622311-
dc.descriptionEl texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.es_PE
dc.description.abstractOBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The 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: We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. RESULTS: Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (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 because of 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 a 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.es
dc.formatapplication/pdfes
dc.language.isoenges
dc.publisherBlackwell Publishing Ltdes
dc.relation.urlhttp://doi.wiley.com/10.1111/hiv.12402es
dc.rightsinfo:eu-repo/semantics/restrictedAccesses
dc.subjectCerebral toxoplasmosises
dc.subjectHIV infectiones
dc.subjectToxoplasmic encephalitises
dc.titleA systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?es
dc.typeinfo:eu-repo/semantics/articlees
dc.identifier.journalHIV Medicinees
dc.contributor.institutionSchool of Medicine; Universidad Peruana de Ciencias Aplicadas (UPC); Lima Peru-
dc.contributor.institutionDepartment of Medicine; Case Western Reserve University; Cleveland OH USA-
dc.contributor.institutionDepartment of Infectious Diseases; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil-
dc.contributor.institutionDepartment of Medicine; Case Western Reserve University; Cleveland OH USA-
dc.contributor.institutionCenter for Public Health Research; Research Institute, Faculty of Medicine; Universidad de San Martin de Porres; Lima Peru-
dc.contributor.institutionMedicine Institute Center for Value Based Care Research; Cleveland Clinic; Cleveland OH USA-
dc.contributor.institutionDepartment of Neurology; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil-
dc.contributor.institutionDepartment of Neurology; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil-
dc.description.peerreviewRevisión por pareses_PE
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