OBJECTIVE: To determine the clinical effectiveness of paramomycin Humatin) in HIV-related cryptosporidial diarrhea. METHODS: 78 HIV-positive pts (average CD4 = 71.7 x 10(6)/L) with cryptosporidiosis received treatment with paramomycin at 1500-2000 mg/day. RESULTS: At the initiation of therapy, diarrhea was mild (2-4 bowel movements/day) in 35%, moderate (5-9/day) in 35% and severe (> 10/day) in 30%. The stool was described as liquid in 77% of cases. Clinical responses to paramomycin were as follows: complete (35%), partial (45%), or none (20%). Microbiologic eradication was documented in 37% of evaluable pts. 1 pt had to discontinue drug because of an allergic reaction. Clinical relapses were noted in 58% of responding pts an average of 2.2 mos after the initiation of paramomycin. In 50% the drug had been tapered or discontinued at the time of relapse. 42% of pts have not suffered a relapse an average of 4.7 mos after the initiation of treatment. In 25%, the drug has been discontinued. Of pts with clinical relapse, 28 were retreated with paramomycin. A partial clinical response was noted in 50%. Sixty-seven percent of pts remain alive an average of 5.9 mos following the diagnosis of cryptosporidiosis, 33% died an average of 3.8 mos following their diagnosis and in 80% cryptosporidium contributed significantly to death. CONCLUSION: 80% of pts with cryptosporidiosis had a favourable clinical response to paramomycin. Relapses were common and on average within 2 mos of initiation of treatment. Significantly fewer pts responded to retreatment with Humatin following relapse.

*AIDS-Related Opportunistic Infections/DRUG THERAPY *Cryptosporidiosis/DRUG THERAPY *HIV Seropositivity/COMPLICATIONS *Paromomycin/THERAPEUTIC USE

www.aegis.org