AIDS-related cerebral toxoplasmosis in São Paulo State, Brazil: marked improvements in the highly active antiretroviral therapy-era but the challenges continue.

ighly active antiretroviral therapy (HAART) significantly educed the cerebral toxoplasmosis incidence in HIV-infected atients from high-income countries.1 However, there is carce epidemiological information about this neurological pportunistic disease in lowand middle-income countries, ncluding Brazil. In this letter, we would like to report some ssues about AIDS-related cerebral toxoplasmosis in São Paulo tate, Brazil. First, cerebral toxoplasmosis is the third ranking IDS-defining disease in the HAART-era,2 representing 10% f admissions at Instituto de Infectologia Emilio Ribas (IIER) and 0% (n=3224) of reported cases among 2001–2005 to the Diviion of Epidemiology Surveillance of the Centro de Referência m Treinamento em DST/AIDS from São Paulo State.3 Second, erebral toxoplasmosis led to the diagnosis of HIV infecion in 35% of cases, and it defined AIDS in 75% of cases dmitted at IIER, suggesting a loss of diagnostic and therpeutic opportunities in a subset of HIV-infected persons n Brazil, a middle-income country with universal and free ccess to HAART.2 Third, short and long-term follow-up data t IIER showed similar outcomes compared with AIDS-related erebral toxoplasmosis from developed countries.1,2 Howver, cerebral toxoplasmosis remains a condition with poor rognosis in the natural history of HIV-infected persons.1,4 ourth, cases reported to the Division of Epidemiology Surveilance of the Centro de Referência em Treinamento em DST/AIDS rom São Paulo State, showed a progressive decline of notied cases of AIDS-related cerebral toxoplasmosis during the AART-era. Fig. 1 shows the evolution of the number of cases rom 1982 to 2010 with 1825 reported cases in 1995 and eclining to 392 cases in 2010. In addition, Fig. 1 shows a onsistent declining of the number of reported AIDS-related erebral toxoplasmosis deaths. Thus, there has been a reducion in the case-fatality rate of cerebral toxoplasmosis from 90% in the pre-HAART-era to ∼30% in recent years. In ontrast to this data, the case-fatality rate at IIER (a teriary referral center) was 13%, suggesting the heterogeneity Virais.