AEGiS-15IAC: Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10104)

Gongora-Rubio F, Gongora DV, Zanon JR
Hospital de Base - Funfarme/ Infectious Diseases Department - Famerp, Sao Jose do Rio Preto -SP, Brazil

BACKGROUND: Several formulae have been developed in an effort to reduce the toxicity of amphotericin B (Amb), but their high costs preclude widespread use. To evaluate the efficacy of Amphotericin B in a fat emulsion, i.e. Intralipid (Amb-IL) in 37 AIDS patients with cryptococcal meningitis (CM). Patients and

METHODS: We retrospectively reviewed data collected in a non-comparative open study between Jan/99 and Dec/01. A dose of Amb-IL, at 0.7 mg/kg/day was infused over 1 hour for 14 days; the dose was then reduced to 0.7 mg/kg every other day. The inclusion criteria included a positive test for HIV antibody, prior or concomitant AIDS-defining opportunistic infection (OI), ages of 13 years or older and a first episode of CM diagnosed by cerebrospinal fluid (CSF) culture, positive India ink preparation or presence of the cryptococcal antigen (Latex). The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms and complete resolution or improvement of the mycological alterations of the CSF. The outcomes were evaluated at two weeks: induction phase (IP) and at the end of treatment or consolidation phase (CP) when the last CSF was available.

RESULTS: Prior to the diagnosis of CM 72% of patients had one or more OI and 67.57% had a concomitant OI. The median CD4-cell count was 32 cells/mm³, the median leukocyte count in the CSF was 29 cells/mm³ and the median cumulative dose of AnfB-IL was 1200 mg (300-2500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP nine patients died (24.32%) and four (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%.

CONCLUSION: AnfB-IL, an inexpensive preparation, might be an alternative to conventional AnfB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs, other than AnfB are available to treat systemic fungal infections.

Keywords: AEGIS, Meningitis, Cryptococcal, Amphotericin B, Acquired Immunodeficiency Syndrome, Fat Emulsions, Intravenous, Opportunistic Infections, Drug Therapy, Combination, Antigens, Fungal, CD4 Lymphocyte Count, Treatment Outcome, Humans, therapy, immunology, diagnosis, cerebrospinal fluid, drug therapy

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B10104