To the Editor.—
We have read with interest the article by Cimino et al1 about patients infected with human immunodeficiency virus (HIV) presenting with brain mass lesions.The fact that one third of their patients with Toxoplasma encephalitis, diagnosed bymeans of brain biopsy, did not respond to treatment with pyrimethamine and sulfadiazine (doses of which were not mentioned by the authors) deserves special attention.Empiric treatment of brain mass lesions in patients with HIV infection with the use of anti-Toxoplasma therapy is currently accepted. Nevertheless, consensus about the optimal daily doses of pyrimethamine and sulfadiazine has not been established. Proposed doses ranged from 25 to 200 mg/d for pyrimethamine and from 4 to 8 g/d for sulfadiazine.2-9Pyrimethamine is a powerful antiToxoplasma drug and, to our knowledge, no in vitro resistances against it have been reported. The Pharmacokinetic profile of pyrimethamine shows a variable half-life bioavailability (35
Iribarren JA, Arrizabalaga J, Garde C, Rodriguez-Arrondo F, Blanco A. Empiric Treatment of Acute Toxoplasma Encephalitis in Patients With Acquired Immunodeficiency Syndrome. Arch Intern Med. 1992;152(10):2139–2140. doi:10.1001/archinte.1992.00400220141026
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