How is toxoplasma retinochoroiditis in HIV infection treated?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Although small, peripheral chorioretinal lesions can be monitored in the immunocompetent patient, immunocompromised hosts with active lesions should be treated regardless of disease extent.

For active chorioretinitis within 2-3 mm of the disc or fovea, which threatens vision, or peripheral lesion associated with severe vitritis, therapy  is continued for 3-6 weeks. First-line regimen is as follows: (1) pyrimethamine 75 mg PO load, 25 mg PO twice daily, plus, (2) folinic acid 3-5 mg PO twice weekly (to reduce the adverse effect of bone marrow toxicity of pyrimethamine), and (3) sulfadiazine 2 g PO load, then 1 g PO 4 times daily.

Clindamycin 300 mg PO 4 times daily may be used alone (if the patient is allergic to sulfa drugs) or in combination with sulfadiazine as alternative treatment. Patients on clindamycin should be monitored for the possible adverse effect of pseudomembranous colitis. Other alternative therapeutic regimens trimethoprim/sulfamethoxazole (160 mg/800 mg) 1 tablet PO twice daily, with or without clindamycin.

Platelet count and CBC should be monitored once to twice weekly for patients on pyrimethamine. If the platelet count falls below 100,000, then a reduction in the dose along with an increase in the dose of folinic acid should be initiated. It is important that patients on pyrimethamine avoid taking vitamins containing folic acid.

Retinal laser photocoagulation, cryotherapy, and vitrectomy have been used as adjunct therapy in the treatment of ocular toxoplasmosis.


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