{"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":1788383808288,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Cerebral toxoplasmosis occurs mainly in immunocompromised hosts as a reactivation of latent Toxoplasma gondii infection. In the diagnostic process, magnetic resonance imaging (MRI), serum testing, and biopsy are used. We describe a case of a 43-year-old HIV-positive patient presenting with altered levels of consciousness, aphasia, and hemiparesis. The patient had a history of antiretroviral therapy discontinuation for about 3 years. MRI revealed lesions, suggesting cerebral toxoplasmosis and subacute hemorrhage, serum tests for Toxoplasma gondii were positive. Antiparasitics and glycocorticosteroids were administered. A decline in viral load and clinical improvement were observed, however CD4+ T-cell count continued to decrease. The patient\u2019s state worsened, he developed CMV and bacterial pneumonia, which led to his death. What is crucial in the management of an HIV-infected patient is effective and continuous antiretroviral therapy. Discontinuation of the treatment may result in AIDS and lead to poor recovery of the CD4+ T-cell population, even after reimplementation of antiretroviral therapy and a decrease in viral load.<\/jats:p>","DOI":"10.3390\/pathogens10040497","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T13:58:04Z","timestamp":1618927084000},"page":"497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cerebral Toxoplasmosis, CMV and Bacterial Pneumonia with Decreasing CD4+ T-Cell Count as Results of Antiretroviral Therapy Discontinuation\u2014A Case Report"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-0128","authenticated-orcid":false,"given":"Marta","family":"Piwowarek","sequence":"first","affiliation":[{"name":"Students\u2019 Science Society of the Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Wolska 37 Street, 01-201 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Siennicka","sequence":"additional","affiliation":[{"name":"Students\u2019 Science Society of the Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Wolska 37 Street, 01-201 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Miku\u0142a","sequence":"additional","affiliation":[{"name":"The Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Wolska 37 Street, 01-201 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Wierci\u0144ska-Drapa\u0142o","sequence":"additional","affiliation":[{"name":"The Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Wolska 37 Street, 01-201 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"ref_1","unstructured":"CDC (2021, February 12). Toxoplasmosis, Available online: www.cdc.gov\/parasites\/toxoplasmosis\/disease.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/pim.12157","article-title":"Toxoplasma gondii-induced neuronal alterations","volume":"37","author":"Parlog","year":"2015","journal-title":"Parasite Immunol."},{"key":"ref_3","first-page":"1","article-title":"HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease","volume":"18","author":"Vidal","year":"2019","journal-title":"J. Int. Assoc. Provid. AIDS Care (JIAPAC)"},{"key":"ref_4","unstructured":"UpToDate (2021, February 12). Toxoplasmosis in Patients with HIV. (n.d.). Available online: https:\/\/www.uptodate.com\/contents\/toxoplasmosis-in-patients-with-hiv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1055\/s-2007-963567","article-title":"Magnetresonanztomografische Befunde des Gehirns bei adulten Patienten mit HIV und AIDS","volume":"180","author":"Kloska","year":"2008","journal-title":"R\u00f6Fo Fortschr. Geb. R\u00f6ntgenstrahlen Bildgeb. Verfahr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18640","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis","volume":"16","author":"Katz","year":"2013","journal-title":"J. Int. AIDS Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1177\/0897190016633978","article-title":"Adherence to Antiretroviral Therapy and Its Determinants Among HIV-Infected Patients in Nigeria","volume":"30","author":"Odili","year":"2017","journal-title":"J. Pharm. Pract."},{"key":"ref_8","unstructured":"Parczewski, M., Boci\u0105ga-Jasik, M., Inglot, M., Mularska, E., and Witak-J\u0119dra, M. (2019). Zasady Opieki nad Osobami Zaka\u017conymi HIV, Polskie Towarzystwo Naukowe AIDS."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s15010-017-1111-3","article-title":"Advances in serological, imaging techniques and molecular diagnosis of Toxoplasma gondii infection","volume":"46","author":"Rostami","year":"2018","journal-title":"Infection"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.pt.2009.07.010","article-title":"LAMP\u2014A powerful and flexible tool for monitoring microbial pathogens","volume":"25","author":"Karanis","year":"2009","journal-title":"Trends Parasitol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1086\/338827","article-title":"Laboratory Diagnosis ofToxoplasma gondiiInfection and Toxoplasmosis","volume":"185","author":"Montoya","year":"2002","journal-title":"J. Infect. Dis."},{"key":"ref_12","unstructured":"ClinicalInfo (2021, February 12). Toxoplasma Gondii Encephalitis. (n.d.), Available online: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/adult-and-adolescent-opportunistic-infection\/toxoplasma-gondii-encephalitis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.2169\/internalmedicine.1156-18","article-title":"Metastatic Malignant Lymphoma Mimicking Cerebral Toxoplasmosis with the \u201cTarget Sign\u201d","volume":"58","author":"Ueno","year":"2019","journal-title":"Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.medmal.2008.10.016","article-title":"Toxoplasmose m\u00e9dullaire au cours de l\u2019infection \u00e0 VIH","volume":"39","author":"Pittner","year":"2009","journal-title":"M\u00e9d. Mal. Infect."},{"key":"ref_15","unstructured":"UpToDate (2021, February 12). Approach to the Patient with HIV and Central Nervous System Lesions. (n.d.). Available online: https:\/\/www.uptodate.com\/contents\/approach-to-the-patient-with-hiv-and-central-nervous-system-lesions."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/3606970","article-title":"Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring","volume":"2018","author":"Chiavazza","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_17","first-page":"e1907","article-title":"Review of cytomegalovirus coinfection in HIV-infected individuals in Africa","volume":"27","author":"Jespersen","year":"2016","journal-title":"Rev. Med. Virol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"G\u00f3mez-Mora, E., Massanella, M., Garc\u00eda, E., Giles, D., Bernad\u00f3, M., Urrea, V., Carrillo, J., Ouchi, D., Puig, J., and Negredo, E. (2017). Elevated humoral response to cytomegalovirus in HIV-infected individuals with poor CD4+ T-cell immune recovery. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0184433"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Christensen-Quick, A., Massanella, M., Frick, A., Rawlings, S.A., Spina, C., Vargas-Meneses, M., Schrier, R., Nakazawa, M., Anderson, C., and Gianella, S. (2019). Subclinical Cytomegalovirus DNA Is Associated with CD4 T Cell Activation and Impaired CD8 T Cell CD107a Expression in People Living with HIV despite Early Antiretroviral Therapy. J. Virol., 93.","DOI":"10.1128\/JVI.00179-19"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1001\/archinte.163.18.2187","article-title":"CD4 T-Lymphocyte Recovery in Individuals with Advanced HIV-1 Infection Receiving Potent Antiretroviral Therapy for 4 YearsThe Swiss HIV Cohort Study","volume":"163","author":"Kaufmann","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1093\/infdis\/jir507","article-title":"Immunologic Failure Despite Suppressive Antiretroviral Therapy Is Related to Activation and Turnover of Memory CD4 Cells","volume":"204","author":"Lederman","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/j.1468-1293.2007.00436.x","article-title":"Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death","volume":"8","author":"Olsen","year":"2007","journal-title":"HIV Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1001\/jama.2014.8722","article-title":"Antiretroviral Treatment of Adult HIV Infection","volume":"312","author":"Aberg","year":"2014","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/QAI.0b013e3181e8c129","article-title":"Relationship Between CD4+ T-Cell Counts\/HIV-1 RNA Plasma Viral Load and AIDS-Defining Events Among Persons Followed in the ACTG Longitudinal Linked Randomized Trials Study","volume":"55","author":"Smurzynski","year":"2010","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/4\/497\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:50:11Z","timestamp":1760161811000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/4\/497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["pathogens10040497"],"URL":"https:\/\/doi.org\/10.3390\/pathogens10040497","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]}}}