Objective:

To describe people living with HIV and neurotoxoplasmosis clinical presentation and common outcomes in the Dominican Republic.

Background:

Despite breakthroughs in HIV testing and ART access, advanced HIV is still a Latin American health concern. The Dominican Republic saw only a 4% reduction in HIV incidence rate during the last 5 years. Suboptimal disease control and opportunistic infections like neurotoxoplasmosis may occur from a lack of specialized healthcare facilities, limited resources, and information availability in remote areas.

Design/Methods:

Retrospective case series study of individuals with HIV and neurotoxoplasmosis diagnosis from 2017 to 2022. Characteristics included demographics, clinical presentation, laboratory, and imaging. Quantitative data was analyzed using dispersion and central tendency, whereas qualitative data was analyzed using frequencies and percentages.

Results:

37 patients with HIV and neurotoxoplasmosis (mean[SD] age, 37.8[9.55] years; 70.2%[26] men) had a median CD4 count of 24 k/uL (IQR 53) and a mean viral load of 329.3 (SD 258). 64%(24) were noncompliant, not treated, or had uncertain HAART status. 29.7%(11) had anemia, 11.1%(4) myasthenia gravis, and 8.1%(3) hypertension. Oropharyngeal candidiasis 29.7%(11) and Tuberculosis 10.8%(4) were common coinfections. Headache (72.9%[27]), hemiparesis (54.1%[20]), and seizures (51.4%[19]) were the most common neurological symptoms. CT scans showed hypodense lesions (72.4%[21]), mass effect (48.6%[18]), patchy white matter hypodensities (32.4%[12]), and vasogenic edema (27.02%[10]).  Within a year, 10.8%(4) had died.

Conclusions:

Although recent advances in HIV management, developing nations still face difficulties in accessing adequate care. HIV patients require continuous monitoring to avoid preventable conditions, such as neurotoxoplasmosis. Given the sociocultural context, what can we do to increase follow-up and HAART adherence?