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Braz J Infect Dis. 2014 Nov-Dec;18(6):609-17. doi: 10.1016/j.bjid.2014.05.008. Epub 2014 Jul 8.

Incidence of congenital toxoplasmosis among infants born to HIV-coinfected mothers: case series and literature review.

Author information

1
Program in Child and Adolescent Health, Universidade Federal de Minas Gerais (UFMG), Pediatrician, Children's Hospital João Paulo II, FHEMIG, Belo Horizonte, MG, Brazil. Electronic address: flaviaacampos@yahoo.com.br.
2
Department of Pediatrics, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
3
School of Medicine, Federal University of Minas Gerais, MG, Brazil.
4
Children's Hospital João Paulo II, FHEMIG, MG, Brazil.
5
Department of Pediatrics, Pediatric Immunology Division, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Abstract

INTRODUCTION:

There is a paucity of data on the occurrence of congenital toxoplasmosis in children born to mothers dually infected with HIV and Toxoplasma gondii.

OBJECTIVE:

To evaluate aspects of the mother-infant pairs associated with vertical transmission of toxoplasmosis in women co-infected with HIV in a referral center for perinatally acquired infections in Belo Horizonte, Brazil.

METHODS:

Descriptive study of HIV vertically exposed children, with congenital toxoplasmosis, followed at a referral center (cohort/Belo Horizonte). Prenatal and post-natal variables for the mother-infant pairs were evaluated. A literature review with no filtering for time and language was performed to identify reports of congenital toxoplasmosis in HIV vertically exposed children.

RESULTS:

Among 2007 HIV vertically exposed children evaluated in the period from 1998 to 2011, 10 cases of congenital toxoplasmosis were identified (incidence: 0.5%, 95% confidence interval: 0.24-0.91). In searching the literature 22 additional cases in 17 reports were found. Combining the findings of our cohort with other reported cases, 50% (16/32) of congenital toxoplasmosis in HIV vertically exposed children were from Brazil. The cases of congenital toxoplasmosis in HIV vertically exposed children identified in Brazil occurred mainly in the post-Highly Active Antiretroviral Therapy era (p=0.002) and presented a lower death rate (p=0.003) than those from other countries. In the cohort/Belo Horizonte, HIV infection was identified mainly during gestation; T. gondii vertical transmission was observed in pregnant women with CD4(+)>500 cells/mm(3) and latent toxoplasmosis. High rates of ocular lesions (87.5%) and central nervous system involvement (70%) were detected.

CONCLUSIONS:

The risk of vertical transmission of T. gondii in HIV-infected women is low and has been usually associated with maternal immunosuppression and elevated viral load. However, our findings of congenital toxoplasmosis in children born to HIV-infected mothers with latent toxoplasmosis and not immunosuppressed emphasize the need for careful follow-up in these cases.

KEYWORDS:

Co-infection; Congenital toxoplasmosis; HIV

PMID:
25017666
DOI:
10.1016/j.bjid.2014.05.008
[Indexed for MEDLINE]
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