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Low-Dose Trimethoprim-Sulfamethoxazole Prophylaxis for Toxoplasmic Encephalitis in Patients with AIDS

Andrew Carr, MBBS; Brett Tindall, BAppSc, MSc; Bruce J. Brew, MBBS; Deborah J. Marriott, BSc, MBBS; John L. Harkness, MBBS; Ronald Penny, DSc, MD; and David A. Cooper, BSc, MD
[+] Article, Author, and Disclosure Information

Grant Support: By a scholarship from the Commonwealth AIDS Research Grants Committee.

Requests for Reprints: Andrew Carr, MBBS, Centre for Immunology, St. Vincent's Hospital, Sydney 2010, Australia.

Current Author Addresses: Drs. Carr, Penny, Marriott, and Harkness: St. Vincent's Hospital, Sydney 2010, Australia.

Drs. Brew and Cooper and Mr. Tindall: National Centre in HIV Epidemiology and Clinical Research, 376 Victoria St, Darlinghurst, Sydney 2010, Australia.

©1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;117(2):106-111. doi:10.7326/0003-4819-117-2-106
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Objective: To determine the efficacy of low-dose trimethoprim-sulfamethoxazole (trimethoprim, 160 mg plus sulfamethoxazole, 800 mg; one tablet twice daily, 2 days per week) as primary prophylaxis against toxoplasmic encephalitis in patients with human immunodeficiency virus (HIV) infection and previous Pneumocystis carinii pneumonia.

Design: A retrospective study.

Setting: Tertiary referral teaching hospital.

Patients: During a 3-year period after primary episodes of P. carinii pneumonia, 60 patients received trimethoprim-sulfamethoxazole, and 95 patients received pentamidine (aerosolized in 78 patients and intravenous in 17 patients) as secondary prophylaxis.

Results: No patient in the trimethoprim-sulfamethoxazole group and no patient seronegative for Toxoplasma gondii developed toxoplasmic encephalitis, compared with 12 of 36 (33%; 95% Cl, 19% to 51%) seropositive patients in the pentamidine group (trimethoprim-sulfamethoxazole compared with pentamidine, P = 0.008). A significant difference was seen in the time to development of toxoplasmic encephalitis between the trimethoprim-sulfamethoxazole group (no case at 1153 days) and the pentamidine group (median time, 460 days) (P = 0.004). Neither the CD4+ lymphocyte count at the start of prophylaxis nor zidovudine therapy during the period of prophylaxis influenced the rate of toxoplasmic encephalitis in any group.

Conclusions: Low-dose trimethoprim-sulfamethoxazole (four tablets per week) appears to be effective prophylaxis against toxoplasmic encephalitis in HIV-infected patients with previous P. carinii pneumonia. A prospective, randomized, controlled study is needed to further evaluate these findings.





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