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Incidence of congenital toxoplasmosis among infants born to HIV-coinfected mothers: case series and literature review.
[congenital toxoplasmosis]
There
is
a
paucity
of
data
on
the
occurrence
of
congenital
toxoplasmosis
in
children
born
to
mothers
dually
infected
with
HIV
and
Toxoplasma
gondii
.
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
.
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
.
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
CD
4
(
+
)
>
500
cells
/
mm
(
3
)
and
latent
toxoplasmosis
.
High
rates
of
ocular
lesions
(
87
.
5
%
)
and
central
nervous
system
involvement
(
70
%
)
were
detected
.
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
.
