AIDSWEEKLY Plus, Monday, December 1, 1997 issue.
Daniel J. DeNoon, Senior Editor
Protease inhibitors get the headlines, but a more conventional combination therapy has saved more lives.
Prophylactic treatment with trimethoprim and sulfamethoxazole (TMP/SMX) is highly effective in preventing new and recurrent Pneumocystis carinii pneumonia (PCP), the most common life-threatening opportunistic infection in AIDS. But patients frequently develop hypersensitivity reactions to the regimen, forcing a switch to other, less effective regiments.
Two techniques have been used to re-initiate TMP/SMX: desensitization via gradual dose escalation, or simple direct rechallenge with the drugs. Data from a clinical trial comparing these two techniques show that patients can benefit from both plans, but that desensitization works significantly better.
"A six-day dose-escalation method of TMP/SMX reintroduction for HIV positive persons with prior treatment-limiting rash or fever was significantly more successful in maintaining subjects on single- strength TMP/SMX daily for six months than direct rechallenge," reported James Stanford of the American Foundation for AIDS Research (AMFAR), New York, at the American Society for Microbiology's 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held September 28 to October 1, 1997, in Toronto, Ontario, Canada. "Importantly, even with the inferior method (direct rechallenge), 55 percent of patients were able to take TMP/SMX again."
The study included patients with HIV infection who developed non- life-threatening rash or fever forcing discontinuation of TMP/SMX. Patients randomized to dose escalation received a six-day incremental dose escalation to one single-strength dose of TMP/SMX; patients randomized to direct rechallenge immediately began receiving one single-strength dose of TMP/SMX. Both groups received concomitant antihistamine therapy starting one day before TMP/SMX reintroduction. Following reintroduction, all patients were maintained on TMP/SMX PCP prophylaxis.
The trial was stopped by its data safety and monitoring board after review of preliminary date from the first 135 subjects showed that significantly more of the dose-escalation patients were able to remain on TMP/SMX for six months (based on final data, P= 0.0017).
Eighty percent of the desensitization group and 55 percent of the direct rechallenge group were able to tolerate TMP/SMX for at least six months. No life-threatening complications occurred in either group.
Copyright (c) 1997 - Charles Henderson, Publisher. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA.
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Copyright © 1997 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA.
Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsfile.com
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