Document 0768
 DOCN  M9470768
 TI    Prevention of relapse of histoplasmosis with fluconazole in patients
       with the acquired immunodeficiency syndrome.
 DT    9409
 AU    Norris S; Wheat J; McKinsey D; Lancaster D; Katz B; Black J; Driks M;
       Baker R; Israel K; Traeger D; et al; Department of Medicine, Indiana
       University School of Medicine,; Indianapolis.
 SO    Am J Med. 1994 Jun;96(6):504-8. Unique Identifier : AIDSLINE
       MED/94288074
 AB    OBJECTIVE: To assess the effectiveness of fluconazole for suppression of
       relapse of histoplasmosis in patients with acquired immunodeficiency
       syndrome (AIDS). DESIGN: Retrospective, nonrandomized, open trial.
       SETTING: Multicenter at two university referral centers and in five
       private practices. PATIENTS: Seventy-six patients with AIDS and
       disseminated histoplasmosis who completed induction treatment with
       amphotericin B, itraconazole, or fluconazole and maintained on treatment
       with fluconazole to prevent relapse. INTERVENTIONS: Fluconazole was
       given at dosages of 100 to 400 mg per day. Patients were followed by
       their primary physicians, who completed questionnaires collecting
       information about treatment and relapse status. Blood and urine
       specimens were submitted periodically for Histoplasma capsulatum var.
       capsulatum antigen determination. MEASUREMENTS AND MAIN RESULTS: Nine of
       the 76 patients relapsed during fluconazole therapy and another was
       removed from the study because of allergic rash. Survival after
       initiation of therapy for histoplasmosis was 94 weeks, ranging from 74
       weeks for those who received less than 1 g of amphotericin B for
       induction and none for maintenance therapy to 156 weeks for those who
       received greater than 1 g for induction and additional amphotericin B
       for maintenance therapy before beginning fluconazole (P < 0.02). Antigen
       levels fell at rates of 0.05 units/week in urine and 0.02 units/week in
       serum in patients who were successfully maintained in remission and
       increased by > or = 2 units/week in 4 of 6 patients who relapsed.
       CONCLUSIONS: Fluconazole > or = 200 mg daily is a reasonable choice for
       chronic suppressive therapy of histoplasmosis in patients who cannot
       take itraconazole because of drug interactions, malabsorption, or side
       effects.
 DE    AIDS-Related Opportunistic Infections/*PREVENTION & CONTROL
       Fluconazole/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/*THERAPEUTIC  USE
       Histoplasmosis/*PREVENTION & CONTROL  Human  Recurrence  Retrospective
       Studies  Support, U.S. Gov't, Non-P.H.S.  Support, U.S. Gov't, P.H.S.
       Survival Analysis  JOURNAL ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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