Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

MULTIPLE OPPORTUNISTIC INFECTIONS PROPHYLAXIS

C. Kaduna
Department of infectious diseases - AIDS Clinical Research Unit Hôpital Pitié Salpétrière - Paris

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 5.3
AIDS 1996, Vol. 10 (Suppl. 2);S4

Despite significant progress in the field of antiretroviral therapy, opportunistic infections remain a major cause of morbidity and mortality in patients with low immune status. The clinical epidemiology hr permitted to evaluate the risk of the different major opportunistic infections according to the level of the immune status and the time of evolution If many of than opportunistic infections can be theoritically prophylaxed, some issues have to be considered for an optimal clinical management The number of patients who benefit from a prophylaxis is depending on the prevalence of the disease, the efficacy rate of the prophylaxis ; the benefit-risk ratio can be increased if a prophylaxis is active on several infections. Cotrimoxazole is highly effective in prevention of pneumocystosis and toxoplasmosis with a low rate of failure (<10%) ; however, theses infections are still very common, due in approximately 50% of the cases to discontinuation of therapy. Other options are the dapsone-pyrimethamine combination. Desentivization procedures in case of mild intolerance to sulfonamides are effective of approximately 50% and recommended before the option of aerosolized pentamidine.

CMV infection, given its prevalence of 40% in patients with less than 50 CD4, its morbidity and consequences on quality of life, has been a major concern for prophylactic strategy. In a placebo-controlled study, oral ganciclovir lead to a decrease of 50% of CMV clinical events in patients with less than 50/mm³. However, the benefit of oral ganciclovir was greatest in patients with the lowest risk of CMV-84% risk reduction (14% to 1%) in PCR negative patients and less in PCR positive patient 26% vs 43% in placebo group ; CMV infected patients without evidence of active CMV replication -PCR negative- appear to be the best candidates for true prophylaxis with oral ganciclovir.

MAC prophylaxis is not extensively used in Europe compared to US ; Rifabutin has been the first drug to demonstrate a 50% reduction rate in occurrence of MAC infection. Clarythromycin is more effective than rifabutin, but leads to the emergence of resistant strains ; azythmmycin, given once weekly, has been recently shown to be as effective as clarythromycin in MAC prophylaxis and has, in addition, a PCP preventive effect.

Because of limiting factors for a large use of all these prophylaxis — tolerance, compliance, consequences on quality of life, and cost, physicians have to evaluate — on an individual patient basis the optimal prophylactic regimen to be added to antiretroviral therapy.

Presenting author: C. Kaduna

1996-11-03
5.3

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

Copyright © 1996 - Lippincott Williams & Wilkins. All rights reserved. All abstracts from the 3rd International Congress Drug Therapy in HIV Infection, appearing on the AEGiS web site, are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, or otherwise published without the prior written permission of Lippincott Williams & Wilkins. You may not alter or remove any trademark, copyright or other notice. However, provided that you maintain all copyright and other notices contained therein, you may download material (one machine readable copy and one print copy per page) for your personal, non-commercial use only.

http://www.aidsonline.com http://www.ovid.com