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HTLV-I and HIV infections of the CNS in tropical areas
  1. B J BREW
  1. Department of Neurology and Neurosciences, St Vincent's Medical Centre, 376 Victoria Street, Darlinghurst, University of New South Wales, Sydney, Australia 2010

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    I read with interest the recent article by Cabreet al.1 I make three comments on the section of the review pertaining to HIV disease. I disagree with the statement made on page 551 that chorea is pathognomonic of toxoplasmosis encephalitis in patients with AIDS. Chorea may also occur in patients with AIDS dementia complex (ADC).2 Secondly, there are several errors in table 2. Fluconazole is not given as 400 mg four times a day for acute cryptococcal meningitis therapy but rather as 400 mg/day; fluconazole is not given as 200 mg four times a day for suppressive therapy but rather as 200 mg/day; pyrimethamine is not given at 50–100 mg four times a day for acute toxoplasmosis therapy nor is folinic acid at 10 mg four times a day or sulfadiazine 4–8 g four times a day but rather pyrimethamine 50–100 mg/day, folinic acid 10 mg/day, and sulfadiazine 4–8 g/day; pyrimethamine for suppressive therapy is not given at 25–75 mg four times a day but rather as 25–75 mg/day and folinic acid should be given at a dose of 10 mg/day; the toxoplasmosis prophylactic dose of trimethoprim 160 mg with sulfamethoxazole is one tablet per day. Finally, the statement on page 552 “antiretroviral therapy can only improve ADC symptoms” is no longer correct. Significant improvement in ADC symptoms, signs, and function (to the point where some patients can return to full-time work) is now possible with highly active antiretroviral therapy.2


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