title: Itraconazole maintenance treatment for histoplasmosis in AIDS: a prospective, multicenter trial.
abstract: OBJECTIVE
  To study the efficacy and safety of maintenance treatment with itraconazole for disseminated histoplasmosis in patients with AIDS.
  
  
  METHODS
  This was a prospective, multicenter, open-label study conducted at university-based hospitals participating in the AIDS Clinical Trial Group (ACTG). Forty-six AIDS patients with mild to moderate disseminated histoplasmosis who had successfully completed 12 weeks of induction treatment with itraconazole were treated with itraconazole, 200 mg once daily (42 patients) or 400 mg once daily (4 patients). Patients were followed at monthly intervals with clinical and laboratory assessment for relapse or toxicity. Primary outcome measures were relapse of histoplasmosis and survival. Secondary outcome measures included drug-limiting toxicity and changes in serum and urine Histoplasma polysaccharide antigen (HPA) levels.
  
  
  RESULTS
  Two patients relapsed during a median follow-up period of 87 weeks. The 1-year relapse-free rate was estimated to be 95.3% (95% CI, 85.3%-99.7%). One relapse may have been related to poor adherence to treatment and the second to concurrent administration of rifampin. From the start of maintenance treatment, the estimated 1-year survival rate was 73.0% (95% CI, 67.5%-77.9%). Five patients discontinued treatment because of suspected drug toxicity, three of whom had possible or probable hepatotoxicity. Median serum and urine HPA levels declined significantly during treatment. The only patient in whom antigen levels rose >2 U developed clinical relapse 1 week later; antigen levels were unavailable in the other relapsing patient.
  
  
  CONCLUSIONS
  Itraconazole, 200 mg daily, is effective in preventing relapse of disseminated histoplasmosis in patients with AIDS. It is generally well tolerated, but clinicians should be alert for drug interactions and possible hepatotoxicity.
authors.affiliation: Albert Einstein College, Bronx, New York, U.S.A.
authors.forename: F M
authors.initials: FM
authors.lastname: Hecht
authors.forename: J
authors.initials: J
authors.lastname: Wheat
authors.forename: A H
authors.initials: AH
authors.lastname: Korzun
authors.forename: R
authors.initials: R
authors.lastname: Hafner
authors.forename: K J
authors.initials: KJ
authors.lastname: Skahan
authors.forename: R
authors.initials: R
authors.lastname: Larsen
authors.forename: M T
authors.initials: MT
authors.lastname: Limjoco
authors.forename: M
authors.initials: M
authors.lastname: Simpson
authors.forename: D
authors.initials: D
authors.lastname: Schneider
authors.forename: M C
authors.initials: MC
authors.lastname: Keefer
authors.forename: R
authors.initials: R
authors.lastname: Clark
authors.forename: K K
authors.initials: KK
authors.lastname: Lai
authors.forename: J M
authors.initials: JM
authors.lastname: Jacobson
authors.forename: K
authors.initials: K
authors.lastname: Squires
authors.forename: J A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: W
authors.initials: W
authors.lastname: Powderly
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000032:analysis / Q000276:immunology; D005260:Female; D006658:Histoplasma / Q000276:immunology; D006660:Histoplasmosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects; D008297:Male; D011134:Polysaccharides / Q000032:analysis / Q000276:immunology; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; D011134:Polysaccharides; D017964:Itraconazole