Document 0244
 DOCN  M9440244
 TI    Primary prophylaxis with pyrimethamine for toxoplasmic encephalitis in
       patients with advanced human immunodeficiency virus disease: results of
       a randomized trial. Terry Beirn Community Programs for Clinical Research
       on AIDS.
 DT    9404
 AU    Jacobson MA; Besch CL; Child C; Hafner R; Matts JP; Muth K; Wentworth
       DN; Neaton JD; Abrams D; Rimland D; et al; Department of Medicine,
       University of California, San Francisco.
 SO    J Infect Dis. 1994 Feb;169(2):384-94. Unique Identifier : AIDSLINE
       MED/94149325
 AB    Pyrimethamine, 25 mg thrice weekly, was evaluated as primary prophylaxis
       for toxoplasmic encephalitis (TE) in a double-blind, randomized clinical
       trial in patients with human immunodeficiency virus (HIV) disease,
       absolute CD4 lymphocyte count of < 200/microL (or prior AIDS-defining
       opportunistic infection), and the presence of serum IgG to Toxoplasma
       gondii. Leucovorin was coadministered only for hematologic toxicity.
       There was a significantly higher death rate among patients receiving
       pyrimethamine (relative risk [RR], 2.5; 95% confidence interval [CI],
       1.3-4.8; P = .006), even after adjusting for factors predictive of
       survival. The TE event rate was low in both treatment groups (not
       significant). Only 1 of 218 patients taking
       trimethoprim-sulfamethoxazole but 7 of 117 taking aerosolized
       pentamidine for prophylaxis against Pneumocystis carinii pneumonia
       developed TE (adjusted RR for the trimethoprim-sulfamethoxazole group,
       0.16; 95% CI, 0.01-1.79; P = .14). Thus, for HIV-infected patients
       receiving trimethoprim-sulfamethoxazole, additional prophylaxis for TE
       appears unnecessary.
 DE    Adult  AIDS-Related Opportunistic Infections/*DRUG THERAPY/MORTALITY
       Female  Human  HIV Infections/*COMPLICATIONS  Male  Middle Age
       Pneumonia, Pneumocystis carinii/COMPLICATIONS/MORTALITY
       Pyrimethamine/*ADVERSE EFFECTS  Support, Non-U.S. Gov't  Support, U.S.
       Gov't, P.H.S.  Toxoplasmosis, Cerebral/*PREVENTION & CONTROL  CLINICAL
       TRIAL  JOURNAL ARTICLE  MULTICENTER STUDY  RANDOMIZED CONTROLLED TRIAL

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