Document 0533
 DOCN  M9440533
 TI    Pharmacotherapy of disseminated histoplasmosis in patients with AIDS.
 DT    9404
 AU    Drew RH; Division of Infectious Diseases, Duke University Medical
       Center,; Durham, NC 27710.
 SO    Ann Pharmacother. 1993 Dec;27(12):1510-8. Unique Identifier : AIDSLINE
       MED/94138140
 AB    OBJECTIVE: To review the pharmacotherapy of disseminated histoplasmosis
       (DH) in patients with AIDS. The article provides an overview of the
       pathophysiology, epidemiology, clinical presentation and diagnosis of
       this disease. Clinical trials reporting intervention with antifungal
       therapy are reviewed, with an emphasis on efficacy and toxicity of these
       agents. DATA SOURCES: A MEDLINE search from 1976 to the present was
       performed to identify pertinent biomedical literature, including
       reviews. STUDY SELECTION: All available reviews and clinical trials in
       AIDS patients were evaluated, as were all available case series and
       interventional clinical trials. DATA SYNTHESIS: DH in patients with HIV
       infection is an AIDS-defining opportunistic infection caused by
       Histoplasma capsulatum. It is most frequently observed in HIV-infected
       patients living in or traveling to endemic regions. The clinical
       presentation most often includes fever and weight loss, but may be
       complicated by comorbid illness such as other opportunistic infections.
       Diagnosis is best established by histologic examination of peripheral
       blood smear or bone marrow aspirate, or isolation of the organism in
       cultures of blood, bone marrow, and respiratory secretions. Serologic
       examinations may provide supportive diagnostic information. Detection of
       histoplasma polysaccharide antigen (HPA) in serum or urine may prove to
       be a promising approach for the rapid diagnosis and therapeutic
       monitoring of DH in AIDS patients. In contrast to immunocompetent hosts,
       high relapse rates are reported after therapy in AIDS patients.
       Therefore, initial (induction) therapy is routinely followed by
       long-term (maintenance) therapy to prevent relapse. Issues regarding the
       selection, dosage, and duration of therapy, as well as prophylaxis of
       patients at highest risk, still need to be addressed by controlled
       clinical trials. CONCLUSIONS: Amphotericin B is presently the drug of
       choice for induction therapy. Maintenance therapy with either
       amphotericin B or an oral azole antifungal agent active against H.
       capsulatum is necessary to prevent relapse. Itraconazole, a triazole
       antifungal agent, may provide effective alternative therapy for both
       induction and maintenance treatment of DH.
 DE    Amphotericin B/*THERAPEUTIC USE  Antifungal Agents/*THERAPEUTIC USE
       AIDS-Related Opportunistic Infections/DIAGNOSIS/*DRUG THERAPY/
       EPIDEMIOLOGY  Clinical Trials  Fluconazole/THERAPEUTIC USE
       Histoplasmosis/DIAGNOSIS/*DRUG THERAPY/EPIDEMIOLOGY  Human
       Itraconazole/THERAPEUTIC USE  Ketoconazole/THERAPEUTIC USE  United
       States  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).