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Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients
S D Nightingale1, S X Cal, D M Peterson
1Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
Objective:
To investigate the efficacy of fluconazole prophylaxis against systemic fungal infections in HIV-positive patients.
Design:
Open label treatment compared with historical controls.
Setting:
Patients were seen at the Parkland Memorial Hospital HIV Clinic, Dallas, Texas, USA between 1 March 1990 and 28 February 1991.
Patients, Participants:
Three hundred and thirty-seven historical controls were followed for 157 patient-years, and 329 fluconazole-treated patients for 145 patient-years.
Interventions:
Fluconazole (100 mg daily) was administered to all patients with CD4 lymphocyte counts less than 68 x 10(6)/l seen at our HIV clinic after 1 March 1990.
Main Outcome Measures:
Lysis-centrifugation blood cultures were recorded monthly for all patients during both study periods.
Results:
Twenty infections (16 cryptococcosis, four histoplasmosis) occurred in 337 historical reference control patients (product-limit 1-year incidence, 7.5 +/- 2.0/year). Four infections (one cryptococcosis, three histoplasmosis) occurred in the treated patient group (product-limit 1-year incidence, 1.8 +/- 0.9/year).
Conclusions:
Fluconazole warrants further evaluation for prophylaxis against systemic fungal infections in HIV-positive patients.