Chemoprophylaxis can prevent toxoplasmic encephalitis in patients immunocompromised due to HIV infection. This can be discontinued in patients with immune reconstitution following highly active antiretroviral therapy (HAART).
Indications for starting primary chemoprophylaxis:
(1) CD4 lymphocyte count < 100 per µL
(2) IgG antibody to Toxoplasma
Primary chemoprophylaxis can be discontinued in a patient receiving HAART if the CD4 > 200 per µL for >= 3 months
Indications for starting secondary chemoprophylaxis:
(1) previous episode of Toxoplasma encephalitis
Secondary chemoprophylaxis can be discontinued in a patient receiving HAART if
(1) the CD4 > 200 per µL for >= 6 months
(2) the patient has completed initial therapy for Toxoplasma
(3) the patient is asymptomatic for toxoplasmosis
Chemoprophylaxis should be restarted:
(1) for primary: CD4 < 100-200 per µL.
(2) for secondary: CD4 < 200 per µL.
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