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dc.contributor.authorHernandez, Adrian V.*
dc.contributor.authorThota, P*
dc.contributor.authorPellegrino, D*
dc.contributor.authorPasupuleti, V*
dc.contributor.authorBenítes-Zapata, Vicente A.*
dc.contributor.authorPenalva de Oliveira, AC*
dc.contributor.authorVidal, JE*
dc.contributor.authorDeshpande, Abhishekes_PE
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.
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
refterms.dateFOA2018-06-15T21:12:20Z
html.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.


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