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Toxoplasmosis in AIDS: Keeping the Lid On

Joseph A. Kovacs, MD
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National Institutes of Health, Bethesda, MD 20892-1662 Requests for Reprints: Joseph A. Kovacs, MD, Building 10, Room 7D43, 10 Center Drive, MSC 1662, Bethesda, MD 20892-1662.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(3):230-231. doi:10.7326/0003-4819-123-3-199508010-00011
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The management of toxoplasmic encephalitis in patients with human immunodeficiency virus (HIV) infection has been a continuously evolving process. Changes in management strategies have been made largely on the basis of clinical experiences, retrospective studies, and small, uncontrolled trials [1]. Currently, HIV-infected patients with neurologic symptoms, low CD4 counts (<100 cells/mm3), and compatible radiographic scans are usually treated empirically for Toxoplasma gondii encephalitis. Acute empiric therapy is usually initiated with either pyrimethamine-sulfadiazine or pyrimethamine-clindamycin [23]; evidence of clinical improvement is seen within 1 to 2 weeks in most responding patients receiving these therapies [45]. Acute therapy is continued until clinical and radiographic resolution occurs, which is usually within 3 to 6 weeks [15].

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