An Unseen Storm

Despite the success of ARV’s, Toxoplasmosis still remains a serious medical concern for people with HIV/AIDS
By Christopher Romano & Timothy Ray Brown

The protozoan intracellular parasite, toxoplasma gondii (toxo), is still one of the most causative agents of disease and death in HIV/AIDS patients even in the post combination antiretroviral therapy era. Estimates indicate that 30 to 50 percent of humans carry the parasite which often causes toxoplasmic encephalitis in immunocompromised populations. Toxoplasmosis remains profoundly under studied and underfunded as evidenced by the fact no one will be talking about this devastating pathogen at this year’s IAS International Conference on HIV Science.

Toxo is no stranger to people living with AIDS. Most remember it as one of the leading causes of death during the early years of the epidemic, but throughout the entire AIDS crisis, nothing has been done about it.

In 2014, the CDC finally identified the disease as a Neglected Parasitic Infection (NPI), “targeting” it for public health action. The following year, Martin Shkreli, then CEO of Turing Pharmaceuticals, infamously purchased exclusive rights to the primary treatment, Daraprim (pyrimethamine), and increased the price 5000% overnight.  The exploitation of this age-old drug sparked outrage across the world and underscores an important issue lying at the core of our healthcare crisis.

The true economic burden of toxoplasmosis is still unknown as the disease often goes unnoticed, misdiagnosed, and unreported, but estimates indicate that toxo costs the U.S. about $7.7 billion per year.

Toxo is not only harmful to HIV/AIDS patients.  All immunocompromised individuals (cancer, diabetes, organ transplant, lyme, lupus, geriatrics, and all vertebrate fetuses) are considered high risk populations.  In addition, studies continue to reveal associations between toxoplasma antibody seropositivity (indicating infection) and the presence of various psychiatric disorders in humans (e.g., schizophrenia, bipolar illness, suicide attempts and memory impairment in elderly persons).

Strangely enough, toxo can only complete its life cycle within the small intestines of cats.  When cats become infected, they shed hundreds of millions of oocyst on their feces. These oocysts contain spores that contaminate the environment causing infection through accidental ingestion or inhalation. It only takes one spore to cause an infection therefore; laboratories are mandated to handle infected cat waste with Biosafety Level 2 procedures (BSL2).

With no cure available to remove or deactivate the final stage of tissue cysts formed by the parasite, protection from the offending pathogen is paramount, especially now considering the unreasonable cost of Daraprim. The good news is that we can prevent exposure to toxo by following two simple guidelines:

1-Avoid unprotected exposure to cat feces
2-Do not eat meat unless it has been cooked to 160 degrees Fahrenheit

Ordering our meals “well-done” may not pose much of a challenge for some, but for those of us who love our cats, dealing with the litter box has truly become a nightmare. That’s why BetterBox, LLC is developing a self-contained cat waste disposal system to protect humans from toxoplasmosis. The company plans to have production units available by 2018. Until then, those at high risk should wear rubber gloves and dust masks when handling a litter box.

As the toxo storm endures and the cost of healthcare soars, we must step back and ask ourselves, “Will we calm this beast simply by altering a few behaviors, or will we stay within the clutches of exploitation and wait for the next Martin Shkreli to take us for a ride?”


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