TreatmentUpdate 72, Vol. 8, No. 8; October 1996
Sean Hosein

One of the life-threatening brain infections PHAs can develop is 'crypto' (Cryptococcal meningitis). Standard treatment is iv AmB (amphotericin B) followed by oral fluconazole as maintenance. AmB can be toxic for the kidneys so researchers have been developing new forms of AmB one of which is called AmBisomer. This product consists of tiny balls of fat called liposomes containing amphotericin B. In theory these liposomes should penetrate the areas infected with the fungus and release the amphotericin there rather than expose the whole body to the drug.

Study details

Doctors in Amsterdam enrolled 28 HIV-infected subjects who had crypto into their study to compare the effects of AmB against that of Ambisome. Fifteen subjects received AmBisome 4 mg/kg of body weight per day for 3 weeks while 13 received AmB 0.7 mg/kg/day also for 3 weeks. After this both groups received oral fluconazole 400 mg/day for 7 days.

Results

Three subjects in each group did not recover during the first 3 weeks of the study. By the end of the 3rd week of the study technicians could not find any fungus in 10 of 15 subjects on AmBisome and in 3 of 8 subjects on AmB. This difference between the two groups was statistically significant, that is, likely due to the effects of the drugs rather than luck. Two subjects receiving AmB had to be withdrawn from the study because of kidney damage. Although the overall effects of AmBisome sound promising, more details are needed about the subjects in the study and their survival over the long term.

REFERENCES:

1. Leenders ACAP, Reiss P, Portegies P, et al . A randomized trial of liposomal amphotericin B (AmBisome) 4 mg/kg versus amphotericin B 0.7 mg/kg for cryptococcal meningitis in HIV-infected patients. Abstract L035.

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