Klein NC, Duncanson FP, Lenox TH, Kawwaff O, Pitta-Alvarez A, Wormser GP; International Conference on AIDS.
Int Conf AIDS. 1989 Jun 4-9; 5: 293 (abstract no. T.B.P.37).
New York Medical College, Valhalla, New York, USA
Despite the high incidence of PCP in HIV infection, few large scale prospective treatment trials have been reported. OBJECTIVE: To compare trimethoprim-sulfamethoxazole (TS) (20 mg T & 100 mg S/kg/day) vs pentamidine isethionate (P) (4 mg/kg/day) both given IV for 21 days. METHODS: One hundred sixty patients were randomized; ninety-two patients received TS and 68 P. RESULTS: There were no significant differences in mean age (TS=36.8 P=36.3), % male (TS=80 P=81), risk factors (% IVDA TS=69 P=63; % homosexual/bisexual men TS=18 P=22; % other TS=13 P=15), % first episode of PCP (TS=91 P=88), mean temperatures (degree F) (TS=102.2 P=102.0), mean A-a 0(2) gradient TS=48 +/- 17 P=44 +/- 20) and mean lymphocyte count (TS=1090 P=1133). On or after day 5(2), patients were evaluated for response to therapy. Failure to complete therapy on initial drug was common 74 (80%) for TS and 47 (69%) for P (NS). Of those receiving TS, 4 died within 5 days, (42%) required change in therapy for failure to respond, and 31 (34%) required change for severe toxicity (neutropenia 15, rash 11, hepatitis 4, nausea and vomiting 4, renal insufficiency 1). Of those receiving P, 3 died within 5 days, 27 (40%) required change in therapy for failure to respond, and 17 (25%) required change for severe toxicity (hypoglycemia 5, neutropenia 4, hypertension 4, rash 3, renal insufficiency 3, fever 1). The overall survival was similar in the TS (67%) vs P (74%) groups. The survival rates for those requiring change in therapy were: TS followed by P (TS-P) due to failure 46%, TS-P due to toxicity 97%; P followed by TS (P-TS) due to failure 56%, P-TS due to toxicity 94%. Survival rates (at end of therapy) for groups not requiring change and completing 5 days of therapy were TS (83%) and P (79%) (NS). CONCLUSION: TS and P are equivalent therapy for PCP in AIDS patients. Neither can be relied on solely in the treatment of this pneumonia. Change in therapy due to drug toxicity is not associated with a worsened survival rate (96%) in contrast to change due to failure to respond (50%) (p less than .01)
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Fever
- Follow-Up Studies
- Humans
- Incidence
- Longitudinal Studies
- Male
- Neutropenia
- Pentamidine
- Pneumonia, Pneumocystis
- Prospective Studies
- Risk Factors
- Survival Rate
- Trimethoprim-Sulfamethoxazole Combination
- therapy
Other ID:
UI: 102177275
From Meeting Abstracts