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

Thota, P.; Pellegrino, D.; Pasupuleti, V.; Benítes-Zapata, Vicente A.; Vidal, J.; Hernández, Adrian V.; Deshpande, Abhishek

dc.contributor.author	Thota, P.	*
dc.contributor.author	Pellegrino, D.	*
dc.contributor.author	Pasupuleti, V.	*
dc.contributor.author	Benítes-Zapata, Vicente A.	*
dc.contributor.author	Vidal, J.	*
dc.contributor.author	Hernández, Adrian V.	*
dc.contributor.author	Deshpande, Abhishek	es_PE
dc.creator	Universidad Peruana de Ciencias Aplicadas (UPC)	es_PE
dc.date.accessioned	2015-10-15T17:25:00Z	es_PE
dc.date.available	2015-10-15T17:25:00Z	es_PE
dc.date.issued	2015-10-15	es_PE
dc.identifier.uri	http://hdl.handle.net/10757/579779	es_PE
dc.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.	es_PE
dc.description	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	es_PE
dc.format	application/html	es_PE
dc.language.iso	eng	es_PE
dc.publisher	IDWeek	es_PE
dc.relation.url	https://idsa.confex.com/idsa/2015/webprogram/Paper53219.html	es_PE
dc.rights	info:eu-repo/semantics/openAccess	es_PE
dc.source	Universidad Peruana de Ciencias Aplicadas (UPC)	es_PE
dc.source	Repositorio Académico - UPC	es_PE
dc.subject	Cerebral toxoplasmosis	es_PE
dc.subject	Trimephoprim-sulfamethaxozole	es_PE
dc.title	A 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.type	info:eu-repo/semantics/conferenceObject	es_PE
refterms.dateFOA	2018-06-15T12:29:26Z