Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized trial. ANRS 005-ACTG 154 Group Members. Agence Nationale de Recherche sur le SIDA. AIDS Clinical Trial Group.
Pyrimethamine (50 mg) with folinic acid (15 mg) given three times weekly was assessed as primary prophylaxis for toxoplasmic encephalitis (TE) in 554 human immunodeficiency virus-infected patients seropositive for Toxoplasma gondii and with < 200 CD4 cells/mm3. At 1 year, the incidence of TE was similar in pyrimethamine, 12%, and placebo, 13%, groups (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6-1.4), and the survival rate was also similar, 85% and 80%, respectively (RR, 0.9; 95% CI, 0.7-1.2). Rash was the only adverse event that appeared significantly more frequently in the pyrimethamine arm (7% vs. 1%). In the on-treatment analysis, the incidence of TE was lower in the pyrimethamine arm, 4%, than in the placebo arm, 12% (P < .006). Thus, pyrimethamine cannot be recommended as a first-line regimen for primary prophylaxis of TE if the patient can take cotrimoxazole. However, it should be considered for patients who are intolerant to cotrimoxazole, especially in high-risk patients with < 100 CD4 cells/mm3.
Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Université Paris 7, France.
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C
Leport
G
G
Chêne
P
P
Morlat
B J
BJ
Luft
F
F
Rousseau
S
S
Pueyo
R
R
Hafner
J
J
Miro
J
J
Aubertin
R
R
Salamon
J L
JL
Vildé
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000517:prevention & control*; D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000913:Antibodies, Protozoan / Q000032:analysis; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D014122:Toxoplasma / Q000276:immunology; D014123:Toxoplasmosis / Q000150:complications; D016781:Toxoplasmosis, Cerebral / Q000401:mortality / Q000517:prevention & control*
D000890:Anti-Infective Agents; D000913:Antibodies, Protozoan; D002955:Leucovorin; D011739:Pyrimethamine