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Long-Term Amphotericin B Therapy for Disseminated Histoplasmosis in Patients with the Acquired Immunodeficiency Syndrome (AIDS)

David S. McKinsey, MD; Mala R. Gupta, MD; Sharon A. Riddler, MD; Michael R. Driks, MD; David L. Smith, MD; and Paul J. Kurtin, MD
[+] Article, Author, and Disclosure Information

This paper was presented in part at the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy, 25 October 1988, Los Angeles, California.

Requests for Reprints: David S. McKinsey, MD, Department of Epidemiology and Infectious Disease, Research Medical Center, 2316 East Meyer Boulevard, Kansas City, MO 64132.

Current Author Addresses: Drs. McKinsey and Smith: Research Medical Center, 2316 East Meyer Boulevard, Kansas City, MO 64132.

Dr. Gupta: Trinity Lutheran Hospital, 3030 Baltimore, Kansas City, MO 64108.

Dr. Riddler: Truman Medical Center, 2301 Holmes, Kansas City, MO 64108.

Dr. Driks: Baptist Medical Center, 6601 Rockhill Road, Kansas City, MO 64131.

Dr. Kurtin: Mayo Clinic, Rochester, MN 55905.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(8):655-659. doi:10.7326/0003-4819-111-8-655
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Study Objective: To assess the efficacy and toxicity of long-term maintenance amphotericin B therapy in preventing relapses after treatment in patients with the acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis.

Design: Open, nonrandomized pilot study.

Setting: Three private, university-affiliated community hospitals.

Patients: We studied 22 consecutive patients with disseminated histoplasmosis and human immunodeficiency virus (HIV) infection. Sixteen patients completed the study, 5 patients died before completing the initial intensive phase of treatment, and 1 patient received a different treatment regimen.

Interventions: Seven patients were treated with an initial intensive course of 1000 mg of amphotericin B, followed by weekly infusions of 50 to 80 mg until a cumulative dose of 2000 mg was attained; biweekly infusions of 50 to 80 mg were then continued indefinitely. Nine patients received an initial amphotericin B course of 2000 mg followed by weekly infusions of 80 mg.

Measurements and Main Results: Of the 7 patients in the 1000-mg intensive regimen group, 6 patients have survived without clinical or laboratory evidence of a histoplasmosis relapse, and 1 died of unrelated causes. Of the 9 patients in the 2000-mg intensive regimen group, 7 patients have survived, 1 patient died of a histoplasmosis relapse, and 1 patient died of other causes. Thus, 13 of 14 patients (93%) who did not die of other causes remained relapse-free. The median follow-up period was 14 months (range, 2 to 23 months). No apparent differences in outcome were observed between patients treated with weekly maintenance regimens and those treated with biweekly maintenance regimens. Sixty-three percent of patients developed intravascular device-related complications.

Conclusions: Long-term, intermittent maintenance amphotericin B therapy in HIV-infected patients with disseminated histoplasmosis is well tolerated and is highly effective in suppressing relapses after treatment.





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