VIII International Conference on AIDS: Pneumocystis carinii pneumonia

VIII International Conference on AIDS: Pneumocystis carinii pneumonia

Seattle Treatment Education Project: STEP Perspective - Volume 4, Number 3 - October 1992
Mari Kitahata, M.D.

Several studies involving new therapies for prophylaxis and treatment of pneumocystis carinii pneumonia (PCP) were presented at the Amsterdam conference in July.

An international multicenter trial comparing the hydroxynaphthoquinone 566C80 to TMP/SMX (Bactrim, Septra) for treatment of mild to moderate PCP in 322 patients showed that 566C80 is less effective, but better tolerated (WeB1019). The variable bioavailability of 566C80, which can only be administered orally, may account for the decreased effectiveness and toxicity. 566C80 can be considered for patients intolerant of first-line regimens. Toma et al (WeB1020) found that the combination of clindamycin and primaquine was as effective and as well tolerated as TMP/SMX for the treatment of the first episode of PCP in 65 patients. A larger clinical trial has been set up to further evaluate this finding.

Girard et al (WeB1017) reported on a randomized controlled trial of dapsone (50 mg/day) and pyrimethamine (50 mg/week) for primary prophylaxis of PCP in 362 symptomatic HIV patients with CD4 counts below 200. Dapsone and pyrimethamine was as effective as aerosolized pentamidine in preventing PCP, but was associated with more side effects. The study was discontinued early because of the significant protective effect observed in the dapsone/pyrimethamine treated group against the development of toxoplasmosis. This regimen may be advantageous in areas of the world where the population has a high prevalence of antibody to toxoplasmosis. The use of adjuvant oral corticosteroids in 37 patients with mild PCP (WeB1016) (baseline oxygen saturation above 90 percent) showed improvement in respiratory rate, heart rate and temperature, and increased exercise tolerance by the third day in the treated group. Long-term clinical benefit was not established and raises the question of whether the risks of steroid therapy are warranted in patients with mild PCP who tend to have a good clinical outcome.
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This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1992. AEGIS.