Document 0477
 DOCN  M9590477
 TI    Primary prevention of cryptococcal meningitis by fluconazole in
       HIV-infected patients [see comments]
 DT    9509
 AU    Quagliarello VJ; Viscoli C; Horwitz RI; Department of Internal Medicine,
       Yale University School of; Medicine, New Haven, CT 06510, USA.
 SO    Lancet. 1995 Mar 4;345(8949):548-52. Unique Identifier : AIDSLINE
       MED/95295427
 CM    Comment in: Lancet 1995 Mar 4;345(8949):530-1
 AB    To evaluate whether oral fluconazole reduces the risk of a first episode
       of cryptococcal meningitis in HIV-infected patients, we conducted a
       case-control study of patients cared for in a university teaching
       hospital and two urban HIV-outpatient clinics. Cases consisted of
       HIV-infected patients with CD4 cell counts less than 250/microL who
       developed a first episode of cryptococcal meningitis between July 1,
       1990, and June 30, 1993. For each case (n = 18), 4 control subjects were
       chosen from HIV-infected patients (CD4 count < 250/microL) whose
       cerebrospinal fluid was negative for cryptococcal antigen and culture,
       and who were matched by age, sex, and time of lumbar puncture. There
       were no significant differences between cases and controls in age, sex,
       insurance status, mean CD4 count, history of oral candidosis, presence
       of a previous AIDS-defining illness, the number of visits to the
       HIV-outpatient clinic, or use of antiretroviral therapy. In the 6 months
       before lumbar puncture, 2 of 18 cases (11%) and 26 of 72 controls (36%)
       were exposed to fluconazole, a finding that gives a matched odds ratio
       (adjusted for race, route of HIV infection, and CD4 count) of 0.08 (95%
       CI 0.01-0.84; p = 0.035) and indicates a 92% protective efficacy. We
       conclude that fluconazole reduces the risk of a first episode of
       cryptococcal meningitis in HIV-infected patients with a CD4 count less
       than 250/microL. Although the optimum dose and duration of fluconazole
       could not be determined, our results suggest that less than daily use
       was effective in the prevention of cryptococcal meningitis.
 DE    Adult  Case-Control Studies  CD4 Lymphocyte Count  Female
       Fluconazole/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE  Human  HIV
       Infections/*COMPLICATIONS  Male  Meningitis, Cryptococcal/*PREVENTION &
       CONTROL  Odds Ratio  Regression Analysis  Risk  Support, Non-U.S. Gov't
       JOURNAL ARTICLE

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