Cerebral Toxoplasmosis in a Treatment Naive HIV Patient with High CD4 Count Responding to Treatment with a Regime of Cotrimoxazole and Pyrimethamine: Do We Need to Start Prophylaxis for Toxoplasmosis at a Higher CD4 Count?

Abstract

Cerebral toxoplasmosis is one of the commonest opportunistic infection of the nervous system in HIV patients. We present a case of gradual onset haemiparesis in an ART naïve HIV patient with high CD4 count who was subsequently diagnosed to be a case of cerebral toxoplasmosis based on radiological and serological investigations. The patient responded to a regime of Cotrimoxazole and Pyrimethamine. His CD4 count at diagnosis was 299/µl. HAART was started after completion of treatment of cerebral toxoplasmosis. Prophylaxis against toxoplasmosis is recommended with cotrimoxazole if the CD4 count is below 200/µl. However, in this case as the patient had developed toxoplasmosis at a CD4 count value above the cut-off value for prophylaxis for cerebral toxoplasmosis, it may be worth considering to starting prophylaxis at a higher CD4 count than 200/µl and continuing for a longer time than the current guidelines.