[Toxoplasmosis: new aspects, diagnosis and treatment]

The position of visceral toxoplasmosis in HIV infection has changed in the late 1980's. The strong prevalence of toxoplasmosis in the French population and the regression of pneumocystosis due to generalization of primary prophylaxis have made cerebral toxoplasmosis the initial manifestation of AIDS in about 20% of the cases. At the same time, a better management of AIDS patients has made it possible to hope for a longer survival, even in patients with very deep immunodeficiency. Altogether, these various elements are in favour of developing a primary prophylaxis in patients at high risk for visceral toxoplasmosis. During the last few years, other visceral forms of this infection have emerged, which are either localized (chorioretinitis, diffuse encephalitis) or disseminated, affecting the lung, liver, heart, muscles, bone marrow and other viscera. These forms usually imply a very severe immunodeficiency. Because of the toxicity of the reference therapy, sulfadiazine-pyrimethamine, attempts are being made at developing more effective and better tolerated treatments. At the moment, the clindamycin-pyrimethamine combination is a possible alternative. Other compounds, and in particular macrolids, are still under study.