AEGiS-15IAC: Antifungal interventions for the primary prevention of cryptococcal disease in persons with HIV: a systematic review.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Antifungal interventions for the primary prevention of cryptococcal disease in persons with HIV: a systematic review.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10408)

Chang LW, Phipps WP, Kennedy GE, Rutherford GW
University of California, San Francisco, San Francisco, United States

BACKGROUND: Cryptococcal disease is a major source of morbidity and mortality in persons with HIV, particularly in the developing world. In this systematic review, the efficacy of antifungals for the primary prevention of cryptococcal disease in persons with HIV will be assessed.

METHODS: We searched for randomised controlled trials of the prophylaxis for cryptococcal disease among persons with HIV infection. Trials were identified through database (MEDLINE, EMBASE, AIDSDRUGS, AIDSLINE, AIDSTRIALS, CINAHL, DARE, and specialized Cochrane registries) and conference abstract searches, as well as inquiries with experts, authors, and pharmaceutical companies. The time period searched was 1982 to January 2004. Articles were reviewed, abstracted, and assessed on methodologic quality. Efficacy was compared using random-effects meta-analysis and computed relative risk ratios with 95% confidence intervals with the primary outcome being cryptococcal disease incidence.

RESULTS: Five randomised controlled trials were identified and included in this study with a total of 1316 participants. The three trials using itraconazole-based interventions were efficacious (RR=0.12, 95% CI=0.03, 0.51, NNT=20), as were the two fluconazole-based intervention trials (RR=0.23, 95% CI=0.09, 0.61, NNT=14). Analysis of overall mortality as a secondary outcome did not find either itraconazole-based (RR=1.12, CI=0.70, 1.80) nor fluconazole-based (RR=0.59, CI=0.14, 2.62) interventions to be efficacious.

CONCLUSIONS: Both itraconazole and fluconazole are effective in the primary prevention of cryptococcal disease in adults with HIV. However, neither of these interventions appear to clearly decrease overall mortality.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Antifungal Agents, Fluconazole, HIV Infections, Primary Prevention, Itraconazole, Incidence, Meta-Analysis, Adult, mortality

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B10408