TreatmentUpdate61; Volume 7, No. 7 - July 1995
Another fungus (H. capsulatum) can cause life- threatening
complications called histo histoplasmosis) in people with
AIDS. Usually this fungus causes disease "in the South
central USA and South America." Although the yeast tends to
attack the lungs first, it can spread to other parts of the
body. Symptoms may include:
+ skin lesions
+ lower than normal levels of red blood cells
+ weight loss
+ swollen liver/spleen/lymph node
People with HIV/AIDS who also develop histo tend to have less
than 100 CD4+ cells. Technicians can test blood and urine
samples for parts of the fungus or identify it with dyes and
a microscope. Treatment is usually amphotericin B or
* STUDY DETAILS
Researchers reported data on 59 subjects (55 males, 4
females), all of whom were having their first bout of histo.
Subjects received itraconazole 300 mg twice daily (total
daily dose of 600 mg) for the first 3 days and then 200 mg
twice daily with meals for 3 months. No subject had severe
histo. Subjects were monitored for up to 14 weeks.
* RESULTS BENEFITS
According to the researchers, 50 subjects improved when they
received itraconazole. These subjects had increased
energy/less fatigue, loss of fever and weight gain. For many
subjects these improvements happened within the first month
of the study. Levels of fungus in the blood and urine fell
dramatically within 2 weeks of using itraconazole. By the 8th
week of the study, most signs/symptoms had cleared in 90% of
the responding subjects.
* DISEASE DESPITE ITRACONAZOLE
Six subjects became worse despite receiving itraconazole, and
2 of those died. The remaining 4 "recovered after being
switched to [AmB]." The doctors did not know why these
subjects did not recover when they received itraconazole.
Two subjects left the study because of side effects from the
itraconazole including; fever, swollen liver, rash, nausea
and vomiting. Once these subjects were given amphotericin B
instead of itraconazole their side effects cleared.
Although the results from this study suggest that
itraconazole is promising treatment histo, it may not be the
best drug for serious cases of histo. It may be interesting
to see results of long term monitoring of subjects treated
with itraconazole and those treated with amphotericin B.
1. Wheat J. Hafner R. Korzun AH, et al. Itraconazole
treatment of disseminated histoplasmosis in patients with the
Acquired Immunodeficiency Syndrome. American Journal of