Efficacy of aerosolized pentamidine and low dose cotrimoxazole for primary prevention of Pneumocystis carinii pneumonia. Dutch AIDS Treatment Group.
Int Conf AIDS 1992 Jul 19-24; 8:We48 (abstract no. WeB 1018) Schneider MM, Hoepelman IM, Danner SA, Nielsen TH, van der Graaf Y, Weigel HM, van der Ende ME, Kolsters AF, Borleffs JC; University Hospital Utrecht, The Netherlands.
BACKGROUND. Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for HIV-infected patients and a CD4-cell count lower than 200 per mm3. There are no studies reported assessing the efficacy of aerosolized pentamidine versus low dose of co-trimoxazole in primary prevention of PCP. So we conducted a prospective randomized multicentre trial comparing aerosolized pentamidine and two low doses of co-trimoxazole. METHODS. 214 HIV-seropositive, PCP-naive patients with a CD4-cell count lower than 200 per mm3 were randomly assigned to either aerosolized pentamidine 300 mg once per month, co-trimoxazole 960 mg or co-trimoxazole 480 mg once daily. The incidence rate of PCP was analyzed with the Mantel log rank test as a function of time spent in the trial. The analysis was performed on a intention-to-treat basis. RESULTS. At interim analysis 6 of 71 patients in the pentamidine arm had a confirmed first period of PCP compared with no cases of PCP in 71 patients in each co-trimoxazole arm (P value = 0.009). There was a much higher incidence of adverse events in the co-trimoxazole 480 mg and 960 mg group than in the pentamidine group (17 and 18 patients versus 2 patients). The mean length of time until adverse reactions occurred was significantly longer in the co-trimoxazole 480 mg group than in the 960 mg group (57 versus 16 days, P value = 0.001). CONCLUSIONS. After one year of follow-up low dose co-trimoxazole is 100 percent effective versus 90 percent effectiveness of aerosolized pentamidine in primary prophylaxis against PCP in HIV-infected patients. An equal beneficial effect of co-trimoxazole 480 mg and co-trimoxazole 960 mg is suggested.
Keywords: AEGIS, Pentamidine, Pneumonia, Pneumocystis carinii, Trimethoprim-Sulfamethoxazole Combination, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Antifungal Agents, Human, therapy, drug therapy, ICA8 920719
WeB1018
