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March 1995

Predictive Marker for the Development of Cerebral Toxoplasmosis in Patients With Human Immunodeficiency Virus Type 1

Arch Neurol. 1995;52(3):229. doi:10.1001/archneur.1995.00540270015003

Patients admitted with cerebral toxoplasmosis tend to respond poorly to antitoxoplasmic drug therapy; therefore, primary prophylaxis for patients at high risk would seem attractive. Primary prophylaxis with trimethoprim-sulfamethoxazole against cerebral toxoplasmosis has recently been shown to be efficacious.1 However, long-term therapy with antitoxoplasmic drugs has frequent side effects; patients with a low risk of developing cerebral toxoplasmosis may not benefit from primary prophylaxis.

In a retrospective analysis of the patients seen in our center between January 1, 1986, and June 1, 1992, we tried to find predictors of subsequent Toxoplasma encephalitis. Only patients with no clinical indications of neuropsychiatric disturbances and computed tomographic or magnetic resonance imaging scans showing no focal lesions were included in the study. All patients underwent complete clinical examination, lumbar puncture, and computed tomographic scanning at intervals of 6 months.

All 45 patients who were eligible for the longitudinal observation were homosexual men, with a