Discussion

Background: Neurocysticercosis (NCC), due to infection with immature stages (cysts) of the pork cestode Taenia solium, is the single most important risk factor for acquired epilepsy worldwide and has a substantial global disease burden. Many regions endemic for NCC are also endemic for HIV/AIDS, yet literature on HIV and NCC co-infection is sparse, and there is no current treatment guidance for this large population group.

To map the currently available literature on NCC and HIV co-infection, with particular focus on clinical characteristics, diagnostic outcomes and treatment of these patients, as well as interactions between anthelmintic, antiepileptic and antiretroviral medications.

Methods: The systematic literature review methodological framework and PRISMA guidelines were followed. A total of 13,777 records identified through database searching and 45 additional records from other sources, were reduced to 57 included studies after a standardised selection process. Included studies were analysed for data relating to the study aims.

Results: One experimental study was identified, of poor methodological quality, which demonstrated improved outcomes in treating intraventricular NCC with raised intracranial pressure with albendazole vs. ventriculoperitoneal shunt insertion plus praziquantel, in a cohort of HIV-positive patients. Twelve observational studies were identified, none of which discussed treatment. Prevalence of NCC was shown to be similar in HIV-positive and -negative populations, with no significant association with CD4 count. Of the 26 cases of HIV and NCC co-infection extracted from 21 case series and case reports, 10 (38%) were from Latin America, 8 (31%) from sub-Saharan Africa and 6 (23%) from the Indian sub-continent. Fourteen suffered with seizures (54%), 12 with headaches (46%) and 10 (38%) had focal neurological deficits. Five (19%) were treated surgically, 15 (58%) received albendazole and 3 (12%) received praziquantel. Four cases could be considered a form of immune reconstitution inflammatory syndrome. Fifteen patients were reported to have clinically improved, and 2 patients died, 1 due to an adverse response after receiving albendazole. No other adverse responses to treatment were reported.

Conclusions: This review highlights the current gaps in the literature on NCC and HIV co-infection. Updated evidence to guide treatment of NCC and HIV co-infection is lacking and further studies are warranted. We will discuss issues relating to T. solium-NCC diagnosis and highlight a pressing research gap on the pharmacovigilance of drug interactions between anthelmintics, antiretrovirals and antiepileptics.