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July 6, 2006
T. Gondii Prophylaxis Can Stop After Immune Restoration (Reuters Health)
July 6, 2006 (Reuters Health)—HIV patients responding to highly active antiretroviral therapy (HAART) do not appear to need prophylaxis against Toxoplasma gondii infection, Spanish researchers report in the July 1st issue of Clinical Infectious Diseases.
As lead investigator Dr. Jose M. Miro told Reuters Health, "Toxoplasmic encephalitis primary and secondary prophylaxis can be safely stopped in patients with effective HAART."
Dr. Miro of Hospital Clinic Universitari, Barcelona and colleagues note that no randomized trials appear to have been conducted to determine whether prophylaxis against toxoplasmic encephalitis can be safely discontinued after a CD4+ cell increases in response to HAART.
To do so, the researchers enrolled 381 patients receiving primary prophylaxis and HAART and who had a median CD4+ cell count of 343 per cubic millimeter. HIV-1 RNA was undetectable in plasma from 318 of the subjects.
After a median follow-up of 25 months, there were no cases of toxoplasmic encephalitis in the 196 patients who discontinued prophylaxis.
Also studied were a further 57 patients who had had a previous episode of toxoplasmic encephalitis and were receiving secondary prophylaxis. They had a median CD4 count of 407 cells per cubic millimeter. After a median follow-up of 30.5 months, there were no episodes of toxoplasmic encephalitis in the 28 patients who discontinued prophylaxis.
The researchers conclude that Toxoplasma prophylaxis can be safely discontinued in patients whose cell count has increased to more than 200 per cubic millimeter for more than 3 months. However, they add that in the absence of further data, it seems prudent to reintroduce prophylaxis if the CD4+ count drops below this level.
