{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:54:26Z","timestamp":1791561266880,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,6,28]],"date-time":"2016-06-28T00:00:00Z","timestamp":1467072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective of this study was to perform a systematic review and meta\u2010analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected adults. The pyrimethamine plus sulfadiazine (P\u2010S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P\u2010C) is the most common alternative treatment. Although trimethoprim\u2010sulfamethoxazole (<jats:styled-content style=\"fixed-case\">TMP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SMX<\/jats:styled-content>) has potential advantages, its use is infrequent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed and four other databases to identify randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>s) were pooled across studies using random\u2010effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine studies were included (five <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s, three retrospective cohort studies and one prospective cohort study). In comparison to P\u2010S, treatment with P\u2010C or <jats:styled-content style=\"fixed-case\">TMP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SMX<\/jats:styled-content> was associated with similar rates of partial or complete clinical response [P\u2010C: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.87; 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 0.70\u20131.08; <jats:styled-content style=\"fixed-case\">TMP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SMX<\/jats:styled-content>:<jats:styled-content style=\"fixed-case\"> RR<\/jats:styled-content> 0.97; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.78\u20131.21], radiological response (P\u2010C: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.92; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.82\u20131.03), skin rash (P\u2010C: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.81; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.56\u20131.17; <jats:styled-content style=\"fixed-case\">TMP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SMX<\/jats:styled-content>:<jats:styled-content style=\"fixed-case\"> RR<\/jats:styled-content> 0.17; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.02\u20131.29), gastrointestinal impairment (P\u2010C: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 5.16; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.66\u201340.11), and drug discontinuation because of adverse events (P\u2010C: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.32; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.07\u20131.47). Liver impairment was more frequent with P\u2010S than P\u2010C (P\u2010C <jats:italic>vs<\/jats:italic>. P\u2010S: <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.48; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.24\u20130.97).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010associated cerebral toxoplasmosis. Use of <jats:styled-content style=\"fixed-case\">TMP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SMX<\/jats:styled-content> as preferred treatment may be consistent with the available evidence and other real\u2010world considerations. Larger comparative studies are needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12402","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T16:16:08Z","timestamp":1467216968000},"page":"115-124","source":"Crossref","is-referenced-by-count":83,"title":["A systematic review and meta\u2010analysis of the relative efficacy and safety of treatment regimens for <scp>HIV<\/scp>\u2010associated cerebral toxoplasmosis: is trimethoprim\u2010sulfamethoxazole a real option?"],"prefix":"10.1111","volume":"18","author":[{"given":"AV","family":"Hernandez","sequence":"first","affiliation":[{"name":"School of Medicine Universidad Peruana de Ciencias Aplicadas (UPC) Lima Peru"},{"name":"Health Outcomes and Clinical Epidemiology Section Department of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Thota","sequence":"additional","affiliation":[{"name":"Department of Medicine Case Western Reserve University Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Instituto de Infectologia Emilio Ribas Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Pasupuleti","sequence":"additional","affiliation":[{"name":"Department of Medicine Case Western Reserve University Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VA","family":"Benites\u2010Zapata","sequence":"additional","affiliation":[{"name":"Center for Public Health Research Research Institute, Faculty of Medicine Universidad de San Martin de Porres Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Medicine Institute Center for Value Based Care Research Cleveland Clinic Cleveland OH USA"},{"name":"Department of Infectious Diseases Medicine Institute Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AC","family":"Penalva de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Neurology Instituto de Infectologia Emilio Ribas Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JE","family":"Vidal","sequence":"additional","affiliation":[{"name":"Department of Neurology Instituto de Infectologia Emilio Ribas Sao Paulo Brazil"},{"name":"Divis\u00e3o de Cl\u00ednica de Mol\u00e9stias Infecciosas e Parasit\u00e1rias Hospital das Cl\u00ednicas Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil"},{"name":"Laborat\u00f3rio de Protozoologia Instituto de Medicina Tropical de S\u00e3o Paulo Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/424877"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjid.2012.10.030"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2012.01033.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2005.19.626"},{"key":"e_1_2_6_6_1","first-page":"125","article-title":"Complications infectieuses pulmonaires et neurologiques d'un sarcome de Kaposi. 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