Cerebral toxoplasmosis in the twenty-first century: long-term clinical outcomes in a retrospective cohort study in the Netherlands

Background: Cerebral toxoplasmosis is a common opportunistic infection in people with HIV (PWH), associated with high morbidity and mortality. It is unclear how clinical characteristics, treatment response and long-term clinical outcomes in PWH with cerebral toxoplasmosis have changed due to improved treatment of HIV. Methods: This single-centre retrospective observational cohort study of PWH with cerebral toxoplasmosis included patients over almost 25 years. Results: 63 eligible patients were identified. Most patients were late presenters presenting with headache and neurological symptoms. Overall survival was 79% over a mean follow up of 15 years. 73% of deaths occurred within the first year after diagnosis. Almost 10% of patients experienced residual impairments. Conclusions: An earlier diagnosis of HIV reduces the incidence of cerebral toxoplasmosis due to timely initiation of cART and anti- Toxoplasma prophylaxis. High index of suspicion by clinicians is vital to timely start anti- Toxoplasma therapy. If treated correctly and timely, overall survival is high.