Rifabutin but not clarithromycin prevents cryptosporidiosis in persons with advanced HIV infection.
BACKGROUND
Macrolides have been reported to be effective for the prevention of cryptosporidiosis in persons with HIV infection.


OBJECTIVE
To evaluate the efficacy of clarithromycin and rifabutin for the prevention of cryptosporidiosis in persons with advanced HIV infection.


METHODS
Cross-protocol analysis involving 2288 individuals with a history of a CD4 cell counts of < or = 100 x 10(6) cell/l who were enrolled in two prospective clinical trials to prevent Mycobacterium avium complex (MAC) infection and cytomegalovirus (CMV) end-organ disease.


METHODS
Clarithromycin 500 mg twice daily, rifabutin 300-450 mg daily, the combination of the two or no MAC prophylaxis.


METHODS
Laboratory-confirmed cryptosporidiosis. Subjects were analyzed in an intent-to-treat and as-treated manner using time-to-event analyses (Cox proportional hazards models).


RESULTS
The median length of follow up was 463 days. The median CD4 count at entry was 29 x 10(6) cell/l (range 0-182). There were 60 cases of cryptosporidiosis during the prospective observational period, with an event rate of 2.2 per 100 person-years. In the intent-to-treat [relative risk (RR) 0.50; 95% confidence interval (CI) 0.26-0.96; P = 0.041 and as-treated (RR 0.42; 95% CI 0.20-0.91; P = 0.03) analyses, rifabutin alone was significantly associated with a lower rate of cryptosporidiosis. Clarithromycin alone was not protective in similar analyses (P = 0.98 and 0.90, respectively).


CONCLUSIONS
In doses used to prevent MAC infection, rifabutin but not clarithromycin decreases the risk of developing cryptosporidiosis in persons with advanced HIV infection who are not receiving potent combination antiretroviral therapy.
Fichtenbaum
C J
CJ
University of Cincinnati College of Medicine, Infectious Diseases Center, Ohio 45267-0405, USA.
Zackin
R
R
Feinberg
J
J
Benson
C
C
Griffiths
J K
JK
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002648:Child; D017291:Clarithromycin / Q000627:therapeutic use*; D003457:Cryptosporidiosis / Q000517:prevention & control*; D016785:Cryptosporidium parvum; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000517:prevention & control; D017828:Rifabutin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D017828:Rifabutin; D017291:Clarithromycin