Cerebral toxoplasmosis in HIV-infected patients: a review

Pathog Glob Health. 2023 Feb;117(1):14-23. doi: 10.1080/20477724.2022.2083977. Epub 2022 Jun 11.


Toxoplasma gondii infection in the central nervous system commonly occurs among immunodeficient patients. Its prevalence is high in countries with a high burden of HIV and low coverage of antiretroviral drugs. The brain is one of the predilections for T. gondii infection due to its low inflammatory reaction, and cerebral toxoplasmosis occurs solely due to the reactivation of a latent infection rather than a new infection. Several immune elements have recently been recognized to have an essential role in the immunopathogenesis of cerebral toxoplasmosis. Although real-time isothermal amplification, next-generation sequencing, and enzyme-linked aptamer assays from blood samples have been the recommended diagnostic tools in some in-vivo studies, a combination of clinical symptoms, serology examination, and neuroimaging are still the daily standard for the presumptive diagnosis of cerebral toxoplasmosis and early anti-toxoplasma administration. Clinical trials are needed to find a new therapy that is less likely to affect folate synthesis, have neuroprotective properties, or cure the latent phase of infection. The development of a vaccine is being extensively tested in animals, but its efficacy and safety for humans are still not proven.

Keywords: Brain; Toxoplasma gondii; human immunodeficiency virus (HIV); myelotoxicity; reactivation.

Publication types

  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections*
  • Animals
  • Antibodies, Protozoan
  • Humans
  • Toxoplasma*
  • Toxoplasmosis, Cerebral* / diagnosis
  • Toxoplasmosis, Cerebral* / drug therapy
  • Toxoplasmosis, Cerebral* / epidemiology


  • Antibodies, Protozoan

Grants and funding

S.D, A.R.G and S.E are supported by Penelitian Kompetitif Nasional Penelitian Terapan, a research grant from the Ministry of Research, Technology and Higher Education, Indonesia. S.D and A.R.G are supported by the National Institute of Health for Using Tryptophan Metabolism and Response to Corticosteroid to Define New Therapeutic Targets for Tuberculosis Meningitis: Integration of Large Scale Clinical, Metabolomic, and Genomic Data” project [R01AI145781].