{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:16:48Z","timestamp":1788383808370,"version":"build-2803163510"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","funder":[{"name":"Intramural Research Program of the National Institutes of Health Clinical Center"},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Toxoplasmic encephalitis (TE) is a life-threatening complication of people with human immunodeficiency virus (PWH) with severe immunodeficiency, especially those with a CD4+ T-cell count &amp;lt;100 cells\/\u00b5L. Following a clinical response to anti-Toxoplasma therapy, and immune reconstitution after initiation of combination antiretroviral therapy (ART), anti-Toxoplasma therapy can be discontinued with a low risk of relapse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>To better understand the evolution of magnetic resonance imaging (MRI)\u2013defined TE lesions in PWH receiving ART, we undertook a retrospective study of PWH initially seen at the National Institutes of Health between 2001 and 2012, who had at least 2 serial MRI scans. Lesion size and change over time were calculated and correlated with clinical parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 24 PWH with TE and serial MRI scans, only 4 had complete clearance of lesions at the last MRI (follow-up, 0.09\u20135.8 years). Of 10 PWH off all anti-Toxoplasma therapy (median, 3.2 years after TE diagnosis), 6 had persistent MRI enhancement. In contrast, all 5 PWH seen in a pre\u2013ART era study who were followed for &amp;gt;6 months had complete clearance of lesions. TE lesion area at diagnosis was associated with the absolute change in area (P &amp;lt; .0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Contrast enhancement can persist even when TE has been successfully treated and anti-Toxoplasma therapy has been stopped, highlighting the need to consider diagnostic alternatives in successfully treated patients with immune reconstitution presenting with new neurologic symptoms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofad208","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T15:29:25Z","timestamp":1681918165000},"source":"Crossref","is-referenced-by-count":6,"title":["Persistence of Human Immunodeficiency Virus\u2013Associated Cerebral Toxoplasmosis Lesions in Successfully Treated Patients Receiving Combination Antiretroviral Therapy"],"prefix":"10.1093","volume":"10","author":[{"given":"Benjamin","family":"Coleman","sequence":"first","affiliation":[{"name":"Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan R","family":"Smith","sequence":"additional","affiliation":[{"name":"Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Proschan","sequence":"additional","affiliation":[{"name":"Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irini","family":"Sereti","sequence":"additional","affiliation":[{"name":"Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dima A","family":"Hammoud","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Imaging, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5191-9880","authenticated-orcid":false,"given":"Joseph A","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health , Bethesda, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,19]]},"reference":[{"key":"2023052003375975900_ofad208-B1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0140-6736(83)91847-0","article-title":"Outbreak of central-nervous-system toxoplasmosis in Western Europe and North America","volume":"1","author":"Luft","year":"1983","journal-title":"Lancet"},{"key":"2023052003375975900_ofad208-B2","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1001\/jama.1984.03350070031018","article-title":"Toxoplasmic encephalitis in patients with acquired immune deficiency syndrome","volume":"252","author":"Luft","year":"1984","journal-title":"JAMA"},{"key":"2023052003375975900_ofad208-B3","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jinf.2017.05.018","article-title":"Incidence, presentation and outcome of toxoplasmosis in HIV infected in the combination antiretroviral therapy era","volume":"75","author":"Martin-Iguacel","year":"2017","journal-title":"J Infect"},{"key":"2023052003375975900_ofad208-B4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/infdis\/173.1.91","article-title":"Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized trial. 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