Objectives The objective of this study was to perform a systematic review and meta‐analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV ‐infected adults. The pyrimethamine plus sulfadiazine (P‐S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P‐C) is the most common alternative treatment. Although trimethoprim‐sulfamethoxazole (TMP ‐SMX ) has potential advantages, its use is infrequent. Methods We searched PubMed and four other databases to identify randomized controlled trials (RCT s) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RR s) were pooled across studies using random‐effects models. Results Nine studies were included (five RCT s, three retrospective cohort studies and one ...