[Successful discontinuation of antifungal secondary prophylaxis in AIDS-related cryptococcosis]

Rev Argent Microbiol. 2004 Jul-Sep;36(3):113-7.
[Article in Spanish]

Abstract

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.

Publication types

  • English Abstract

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Adolescent
  • Adult
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Cryptococcosis / drug therapy
  • Cryptococcosis / prevention & control*
  • Female
  • Fluconazole / administration & dosage
  • Fluconazole / therapeutic use*
  • Humans
  • Immunocompetence
  • Male
  • Meningitis, Cryptococcal / drug therapy
  • Middle Aged
  • Secondary Prevention
  • Viral Load
  • Withholding Treatment

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole