Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS

Citation
D. Schurmann et al., Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS, J INFECTION, 42(1), 2001, pp. 8-15
Citations number
49
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Immunology
Journal title
JOURNAL OF INFECTION
ISSN journal
0163-4453 → ACNP
Volume
42
Issue
1
Year of publication
2001
Pages
8 - 15
Database
ISI
SICI code
0163-4453(200101)42:1<8:TPEPPC>2.0.ZU;2-O
Abstract
Objective: To evaluate the safety and efficacy of a fixed 25 mg pyrimethami ne-500 mg sulfadoxine combination plus 15 mg folinic acid given twice weekl y for the prevention of relapses of Pneumocystis carinii pneumonia (PCP) an d primary episodes of toxoplasmic encephalitis. Methods: Ninety-five HIV-infected patients with successfully treated PCP an d without history of toxoplasmic encephalitis were enrolled between January 1990 and October 1995 in a single-arm open-label prospective study. No pat ient was receiving highly active antiretroviral treatment, including protea se inhibitors or non-nucleoside reverse transcriptase inhibitors, while on study medication. Efficacy was analysed on an "as-treated" basis. Results: Five patients (5.3%) suffered a PCP relapse while on study medicat ion, three of whom had been non-compliant. No relapse occurred in the first year. Probabilities of freedom from relapse were 0.96 after 24 months and 0.90 after 36 months. Of 69 patients positive for anti-toxoplasma IgG antib odies, one (1.5%) developed cerebral lesions compatible with toxoplasmic en cephalitis after 50 months. Cutaneous allergic reactions were observed in 1 6 patients (16.8%) resulting in permanent discontinuation in six patients ( 6.3%). Two patients (2.1%) developed serious adverse reactions (Stevens-Joh nson syndrome), both of whom had continued prophylaxis despite progressive hypersensitivity reactions. Conclusions: The prophylactic regimen used is effective in preventing PCP r elapses and toxoplasmic encephalitis. The regimen appears to be safe. Sever e adverse events can likely be prevented by discontinuation of prophylaxis at the time allergic reactions are noted. Rechallenge frequently results in tolerance of the regimen. Efficacy and safety compare favourably with prev iously studied regimens. This simple prophylactic regimen may provide a con venient alternative for patients unable to tolerate approved regimens. (C) 2001 The British Infection Society.