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Toxoplasmosis in Patients With HIV: Basic Facts

October 19, 2015

What Is Toxoplasmosis?

The Centers for Disease Control and Prevention has identified toxoplasmosis as one of five neglected parasitic infections (NPIs) that they have targeted for public health action because of the number of people infected, the severity of illnesses and the ability to prevent and treat them.

The Toxoplasma parasite infects nearly all animals and birds and is carried by more than 60 million men, women, and children in the U.S. Toxoplasmosis is a zoonosis, an infection/disease spread from animals to humans, and humans typically become infected by ingesting the cyst form of the parasite through contamination with cat feces or undercooked meat, especially pork and lamb, or through direct inoculation via blood transfusions, transplant, laboratory accidents or mother to child transmission. In the U.S. it is estimated that 22.5% of the population 12 years and older have been infected with Toxoplasma but the infection only progresses to illness in individuals with compromised immune systems, such as HIV and cancer, and pregnant women because their immune system is unable to control the parasite. Severe toxoplasmosis can cause brain and organ damage and result in blindness. Additional information is available from the CDC.


How Many People Are Affected in the U.S.?

CDC estimates that 4,428 patients are hospitalized each year due to toxoplasmosis.

For more information, please contact the CDC Press Office by phone (404) 639-3286 or email media@cdc.gov).


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Toxoplasmosis Treatment Standards for HIV-Infected Patients

Patients require a minimum of 8 months of treatment with most patients requiring a year or more. The Department of Health and Human Services maintains guidelines on the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. The guidelines recommend that patients complete a course of acute therapy for a minimum of six weeks and then continue maintenance therapy until their CD4 counts are >200 cells/uL after antiretroviral treatment that is sustained for more than 6 months.

Online at: https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/322/toxo. See "Treating Disease" "When to Start Secondary Prophylaxis" and "When to Stop Secondary Prophylaxis."


Toxoplasmosis Prophylaxis in Transplant Recipients

Approximately 2,000 heart transplants are performed each year in the US and about half are among recipients who are seronegative for toxoplasmosis. It is recommended that after heart transplantation seronegative recipients of seropositive organs receive prophylaxis for 6 months.


Need for New Treatments

The current treatment regimens work well and are effective when the treatment course is followed. However, Toxoplasmosis cannot be cured nor the infection eradicated.

While we strongly support investment in treatment for infectious diseases, the health of patients who are living with the disease right now should not be compromised in order to develop new therapies that are likely to also be priced out of reach.


Price Increase for Daraprim (Pyrimethamine)

Drug prices differ by payers and are not publicly available. The jump from $13.50 to $750 was reported by a hospital pharmacy in Cleveland, Ohio. Other reports indicate the price before the increase was $16 to $18.

Safety-net clinics and safety-net hospital outpatient pharmacies eligible for the 340B program and other federal outpatient programs have access to the drug at a deeply discounted rate. The discounted rate does not extend to inpatient care. See HRSA Frequently Asked Questions.


Availability Through Patient Assistance Programs

Patient assistance programs play an important role in providing access to medications for patients without insurance or who have limited health insurance coverage. However, the initiation of therapy for toxoplasmosis, in particular when it involves vital organs like the brain or the eye, must be immediate and usually done empirically and cannot wait for the level of paperwork and documentation required for a patient assistance program to be approved. Thus, in addition to the length of time it can take to process the applications, this poses significant risks for patients with acute and serious conditions, such as toxoplasmosis, and can result in dangerous delays in treatment.


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This article was provided by HIV Medicine Association. Visit HIVMA's website to find out more about their activities, publications and services.
 

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