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Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS

A Carr1, B Tindall, B J Brew

  • 1St. Vincent's Hospital, Sydney, Australia.

Annals of Internal Medicine
|July 15, 1992
PubMed
Abstract

Insights

Low-dose trimethoprim-sulfamethoxazole effectively prevents toxoplasmic encephalitis in HIV patients with prior Pneumocystis pneumonia. This regimen offers a significant protective benefit compared to pentamidine prophylaxis.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Pharmacology

Background:

  • Toxoplasmic encephalitis is a serious opportunistic infection in human immunodeficiency virus (HIV) patients.
  • Primary prophylaxis is crucial for preventing toxoplasmic encephalitis in immunocompromised individuals.
  • Previous Pneumocystis carinii pneumonia is a risk factor for toxoplasmic encephalitis in HIV patients.

Purpose of the Study:

  • To evaluate the efficacy of low-dose trimethoprim-sulfamethoxazole as primary prophylaxis against toxoplasmic encephalitis.
  • To compare the effectiveness of trimethoprim-sulfamethoxazole with pentamidine for secondary prophylaxis in HIV patients with a history of Pneumocystis carinii pneumonia.

Main Methods:

  • Retrospective study conducted at a tertiary referral teaching hospital.
  • 60 HIV patients received low-dose trimethoprim-sulfamethoxazole (160 mg trimethoprim/800 mg sulfamethoxazole, twice daily, 2 days/week).
  • 95 HIV patients received pentamidine (aerosolized or intravenous) as secondary prophylaxis.

Main Results:

  • No cases of toxoplasmic encephalitis occurred in the trimethoprim-sulfamethoxazole group.
  • 12 of 36 (33%) seropositive patients in the pentamidine group developed toxoplasmic encephalitis (P = 0.008).
  • Time to toxoplasmic encephalitis was significantly longer in the trimethoprim-sulfamethoxazole group (1153 days) compared to the pentamidine group (median 460 days) (P = 0.004).

Conclusions:

  • Low-dose trimethoprim-sulfamethoxazole (four tablets weekly) is an effective prophylactic agent against toxoplasmic encephalitis in HIV patients with prior Pneumocystis pneumonia.
  • Further evaluation through a prospective, randomized, controlled study is recommended.
  • This regimen offers a potentially safer and more effective alternative for prophylaxis.

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