[Successful discontinuation of antifungal secondary prophylaxis in AIDS-related cryptococcosis].
The clinical and laboratory data of 22 patients with AIDS related cryptococcosis who were able to interrupt antifungal secondary prophylaxis after HAART administration, are presented. They were 14 males and 8 females, between 15 and 50 years old (X: 34 years old). All patients presented fever and severe deterioration of their general health status, and 19 exhibited a meningeal syndrome. At the start of antifungal treatment, 59% of the cases presented < 50 CD4+ cells/microl, the median viral burden was 134,804 RNA copies/ml and the median titer of serum cryptococcal antigen was 1/3,000. Amphotericin B by intravenous route, (0.7 mg/kg/day) or fluconazole (600 to 800 mg/day) were given as a treatment of the initial episode, up to CSF cultures negativization. Oral fluconazole (200 mg/day) or intravenous amphotericin B, 50 mg twice a week, were given as a secondary prophylaxis. The secondary prophylaxis was interrupted when the patients had received HAART for an average lapse of 19 months (6 to 36 months) and the median CD4+ cell count was 249/microl. The follow up after secondary prophylaxis discontinuation lasted for a median lapse of 22 months. These data seem to show that secondary prophylaxis is not necessary when the patient are clinically asymptomatic and the CD4+ cell counts are above 150/microl.
Negroni
R
R
Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Uspallata 2272, (1282), Ciudad Autónoma de Buenos Aires, Argentina. ricardox@janssen.com.ar
Helou
S H
SH
López Daneri
G
G
Robles
A M
AM
Arechavala
A I
AI
Bianchi
M H
MH
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003453:Cryptococcosis / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy; D008875:Middle Aged; D055502:Secondary Prevention; D019562:Viral Load; D028761:Withholding Treatment
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole