Itraconazole maintenance treatment for histoplasmosis in AIDS: a prospective, multicenter trial.

Published

Journal Article

PURPOSE: To study the efficacy and safety of maintenance treatment with itraconazole for disseminated histoplasmosis in patients with AIDS. PATIENTS AND METHODS: This was a prospective, multicenter, open-label study conducted at university-based hospitals participating in the AIDS Clinical Trial Group (ACTG). Forty-six AIDS patients with mild to moderate disseminated histoplasmosis who had successfully completed 12 weeks of induction treatment with itraconazole were treated with itraconazole, 200 mg once daily (42 patients) or 400 mg once daily (4 patients). Patients were followed at monthly intervals with clinical and laboratory assessment for relapse or toxicity. Primary outcome measures were relapse of histoplasmosis and survival. Secondary outcome measures included drug-limiting toxicity and changes in serum and urine Histoplasma polysaccharide antigen (HPA) levels. RESULTS: Two patients relapsed during a median follow-up period of 87 weeks. The 1-year relapse-free rate was estimated to be 95.3% (95% CI, 85.3%-99.7%). One relapse may have been related to poor adherence to treatment and the second to concurrent administration of rifampin. From the start of maintenance treatment, the estimated 1-year survival rate was 73.0% (95% CI, 67.5%-77.9%). Five patients discontinued treatment because of suspected drug toxicity, three of whom had possible or probable hepatotoxicity. Median serum and urine HPA levels declined significantly during treatment. The only patient in whom antigen levels rose >2 U developed clinical relapse 1 week later; antigen levels were unavailable in the other relapsing patient. CONCLUSIONS: Itraconazole, 200 mg daily, is effective in preventing relapse of disseminated histoplasmosis in patients with AIDS. It is generally well tolerated, but clinicians should be alert for drug interactions and possible hepatotoxicity.

Full Text

Duke Authors

Cited Authors

  • Hecht, FM; Wheat, J; Korzun, AH; Hafner, R; Skahan, KJ; Larsen, R; Limjoco, MT; Simpson, M; Schneider, D; Keefer, MC; Clark, R; Lai, KK; Jacobson, JM; Squires, K; Bartlett, JA; Powderly, W

Published Date

  • October 1, 1997

Published In

Volume / Issue

  • 16 / 2

Start / End Page

  • 100 - 107

PubMed ID

  • 9358104

Pubmed Central ID

  • 9358104

International Standard Serial Number (ISSN)

  • 1077-9450

Digital Object Identifier (DOI)

  • 10.1097/00042560-199710010-00005

Language

  • eng

Conference Location

  • United States