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Previous Volume 339:1739-1743 December 10, 1998 Number 24 Next

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ABSTRACT

Background In Southeast Asia, disseminated infection with Penicillium marneffei is common among patients with human immunodeficiency virus (HIV) infection. Even after successful primary treatment, the relapse rate for this potentially fatal systemic fungal infection is about 50 percent.

Methods We conducted a double-blind trial in Thailand to evaluate itraconazole as secondary prophylaxis against P. marneffei infection in patients with the acquired immunodeficiency syndrome (AIDS) who were in complete remission after treatment for culture-proved P. marneffei infection. The patients were randomly assigned to receive either oral itraconazole (200 mg daily) or placebo as maintenance therapy.

Results Of the 72 HIV-infected patients who completed initial treatment for P. marneffei infection, 71 were enrolled in the maintenance study. None of the 36 patients assigned to itraconazole had a relapse of P. marneffei infection within one year, whereas 20 of the 35 patients assigned to placebo (57 percent) had relapses (P<0.001). Among the 20 patients who had relapses, P. marneffei was cultured from blood (15 patients), lymph-node tissue (3 patients), skin (3 patients), and sputum (1 patient). The median time to relapse was 24 weeks after the completion of the initial treatment (95 percent confidence interval, 19.0 to 36.1). Survival and toxic effects were similar in the two groups.

Conclusions In patients infected with HIV who have completed successful primary treatment of P. marneffei infection, secondary prophylaxis with oral itraconazole is well tolerated and prevents relapses of this opportunistic infection.

Source Information

From the Department of Medicine, Chiang Mai University, Chiang Mai, Thailand (K.S., T.S.); the Joint United Nations Program on HIV/AIDS, Geneva (J.P.); and the Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore (K.E.N.).

Address reprint requests to Dr. Sirisanthana at the Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

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