Toxoplasmosis in HIV/AIDS: a living legacy.

Veeranoot Nissapatorn
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Abstract

Toxoplasmosis has historically been considered one of the most important opportunistic infections detected in HIV/AIDS patients. The prevalence rates of latent Toxoplasma infections in HIV-infected patients has been found to vary greatly from 3% to 97%. Prevalence has been found to be related to ethnicity, certain risk factors, and reactivation of toxoplasmosis. Prior to antiretroviral therapy, toxoplasmic encephalitis (TE) was the most common focal cerebral lesion detected in AIDS patients with Toxoplasma infection, occurring in approximately half of Toxoplasma-seropositive patients. Other forms of dissemination have also been reported in AIDS patients in sites such as the eyes, lungs, heart and spinal cord. Anti-Toxoplasma therapy and chemoprophylaxis have shown effectiveness in reducing the incidence of TE, while noncompliance has been identified as a cause of relapse in these settings. Toxoplasmosis is one of the most common neuropathological complications found at autopsy. Rapid progress in the development of highly active antiretroviral therapy (HAART) has changed the observed patterns with TE, for which there has been a marked decrease in overall incidence. Subsequently, TE has been found to be significantly associated with the so-called "neurological immune restoration inflammatory syndrome" (NIRIS). Toxoplasma screening programs are recommended for all newly diagnosed HIV-positive patients. Chemoprophylaxis should be considered in HIV-infected patients who have a CD4 < 200 cells/mm3, particularly in settings where resources are limited and there is not access to HAART. TE remains a cause of morbidity and mortality among AIDS patients.

艾滋病毒/艾滋病中的弓形虫病:一个活生生的遗产。
弓形虫病历来被认为是艾滋病毒/艾滋病患者中检测到的最重要的机会性感染之一。艾滋病毒感染者的潜伏弓形虫感染率从3%到97%不等。已发现患病率与种族、某些危险因素和弓形虫病的再激活有关。在接受抗逆转录病毒治疗之前,弓形虫性脑炎(TE)是在感染弓形虫的艾滋病患者中检测到的最常见的局灶性脑病变,发生在大约一半的弓形虫血清阳性患者中。据报道,在艾滋病患者的眼睛、肺、心脏和脊髓等部位也有其他形式的传播。抗弓形虫治疗和化学预防已显示出降低TE发病率的有效性,而在这些情况下,不遵守已被确定为复发的原因。弓形虫病是尸检中发现的最常见的神经病理并发症之一。高效抗逆转录病毒疗法(HAART)的快速发展改变了TE的观察模式,其总发病率显著下降。随后,TE被发现与所谓的“神经免疫恢复炎症综合征”(NIRIS)显著相关。建议对所有新诊断的艾滋病毒阳性患者进行弓形虫筛查。CD4 < 200细胞/mm3的艾滋病毒感染者应考虑化学预防,特别是在资源有限和无法获得HAART治疗的环境中。TE仍然是艾滋病患者发病和死亡的一个原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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