AEGiS-11IAC: Long term efficacy of low dose intermittent cotrimoxazole for Pneumocystis carinii prophylaxis in AIDS patients.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Long term efficacy of low dose intermittent cotrimoxazole for Pneumocystis carinii prophylaxis in AIDS patients.

Int Conf AIDS 1996 Jul 7-12; 11:443 (abstract no. Pub.B.1031)
Belloso W, Marchetti M, Lopardo G, Quir; Paraguay, Argentina. Fax: 541 962 8480.

Although CDCP current recommendations for Pneumocystis carinii pneumonia (PCP) prophylaxis refer to daily cotrimoxazole dosing, several studies have shown the efficacy of intermittent regimens. Most of them, however, used 6 or more double strength tablets per week and the long term efficacy of cotrimoxazole has not been adequately addressed. This may prove to be important, since most prophylaxis failures have been reported in patients receiving regimens for more than 1 year.

OBJECTIVE: To assess the efficacy of cotrimoxazole for PCP prophylaxis in patients who tolerate this drug for more than one year.

METHODS: We retrospectively reviewed the records of 555 HIV-positive patients receiving primary or secondary PCP prophylaxis for more than one year, evaluating patients that received low dose intermittent cotrimoxazole prophylaxis. We considered 3 or 4 double strength tablets per week as a low dose regimen. We evaluated overall efficacy -considering both proven and clinically suspected episodes of PCP-, bacterial infections, antiretroviral therapy and adverse events.

RESULTS: Seventy seven patients received low dose intermittent regimens for more than one year (29.8% secondary prophylaxis). Seventy one (92.2%) patients were male, the mean age was 35 years; 65.5% were homo/bisexuals, 12.5% were IVDU and 15.5% were heterosexuals. Mean and median CD4+ count at the beginning of prophylaxis were 156 (SD 60) and 160/mm3 (r 2-310), respectively. Seventy (90.9%) patients received concurrent antiretroviral therapy (50.6% combined schemes). Mean follow up was 23 months (r 12-49). Two patients developed PCP during the study period (rate 0.001 per patient/month). One of them was proven and the other was clinically suspected in a non compliant. Thirteen (16.8%) patients had bacterial infections. Eight patients had adverse events.

CONCLUSIONS: Our study shows that the efficacy of low dose intermittent prophylaxis with cotrimoxazole in patients who tolerated the drug for at least one year is similar to that reported with higher dose regimens. Studies with shorter follow up may fail in detecting breakthrough PCP. The best cotrimoxazole regimen for PCP prophylaxis has not yet been defined; finding equally effective low dose intermittent regimens would improve compliance, reduce adverse events and costs, which is an important goal, specially in developing countries.

Keywords: AEGIS, Trimethoprim-Sulfamethoxazole Combination, Pneumonia, Pneumocystis carinii, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, HIV Infections, AIDS Dementia Complex, Anti-HIV Agents, Antifungal Agents, Heterosexuality, Male, Human, prevention & control, ICA11

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PubB1031