Summary
Prophylaxis for toxoplasma encephalitis was performed with pyrimethamine alone (50 mg daily) in 56 patients with advanced HIV infection. Thirty-eight patients were at high risk for toxoplasma encephalitis (CD4+ counts ≤200/ µl, and presence of serum IgG antibodies toToxoplasma gondii). The overall treatment period was 697 months (mean 12.5±12.1). During prophylaxis, only one patient developed toxoplasma encephalitis, four patients discontinued treatment due to adverse reactions. Steady state pyrimethamine plasma concentrations were measured by gas chromatography. Mean plasma level was 1,887±1,161 ng/ml, during liver enzyme-inducing comedication plasma levels were significantly (p=0.0001) reduced (1,488±884 ng/ml versus 1,978±1,196 ng/ml without comedication). All patients received a folinic acid supplement of 7.5 mg daily. Serum folate levels ranged from 5.7–105 (43.7±29.2) nmol/l; severe hematological side effects did not occur.
Zusammenfassung
Bei 56 Patienten mit fortgeschrittener HIV-Infektion wurde eine Prophylaxe der cerebralen Toxoplasmose mit Pyrimethamin als Monotherapie in einer Dosierung von 50 mg täglich durchgeführt. 38 dieser Patienten wiesen ein hohes Risiko für die Entwicklung einer Toxoplasma-Encephalitis auf (CD4+-Zellen ≤200/µl und Nachweis von IgG-Antikörpern gegenToxoplasma gondii). Die gesamte Behandlungsdauer betrug 697 Monate (im Mittel 12,5±12,1). Während der Prophylaxe entwickelte lediglich ein Patient eine cerebrale Toxoplasmose, vier Patienten brachen die Behandlung wegen Nebenwirkungen ab. Steady-state-Pyrimethamin-Plasmakonzentrationen wurden durch Gaschromatographie bestimmt. Der mittlere Plasmaspiegel betrug 1.887±1.161 ng/ml, während einer Leberenzym-induzierenden Komedikation wurden signifikant (p=0,0001) verminderte (1.488±884 ng/ml vs. 1.978±1.196 ng/ml ohne Komedikation) Plasmakonzentrationen gemessen. Alle Patienten erhielten additiv 7,5 mg Folinsäure pro Tag. Die gemessenen Serum-Folsäurespiegel schwankten zwischen 5,7 und 105 (43,7±29,2) nmol/l, schwerwiegende hämatologische Nebenwirkungen traten hierunter nicht auf.
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References
Luft, B. J., Remington, J. S. AIDS commentary. Toxoplasmic encephalitis. J. Infect. Dis. 157 (1988) 1–6.
Zangerle, R., Allerberger, F., Pohl, P., Fritsch, P., Dierich, M. P. High risk of developing toxoplasmic encephalitis in AIDS patients seropositive toToxoplasma gondii. Med. Microbiol. Immunol. 180 (1991) 59–66.
Grant, L. H., Gold, J. W., Rosenblum, M., Niedzwiecki, D., Armstrong, D. Toxoplasma gondii serology in HIV-infected patients: the development of central nervous system toxoplasmosis in AIDS. AIDS 4 (1990) 519–521.
Pedrol, E., González-Clemente, J. M., Gatell, J. M., Mallolas, J., Miró, J. M., Graus, F., Alvarez, R., Mercader, J. M., Berenguer, J., Jiménez de Anta, M. T., Valls, M. E., Soriano, E. Central nervous system toxoplasmosis in AIDS patients: efficacy of an intermittent maintenance therapy. AIDS 4 (1990) 511–517.
Haverkos, J. W. Assessment of therapy for toxoplasma encephalitis. The TE Study Group. Am. J. Med. 82 (1987) 907–914.
Porter, S. B., Sande, M. A. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N. Engl. J. Med 327 (1992) 1643–1648.
Weiss, L. M., Harris, C., Berger, M., Tanowitz, H. B., Wittner, M. Pyrimethamine concentrations in serum and cerebrospinal fluid during treatment of acute toxoplasma encephalitis in patients with AIDS. J. Infect. Dis. 157 (1988) 580–583.
Bachmeyer, C., Gorin, I., Deleuze, J., Morini, J. P., Excande, J. P. Pyrimethamine as primary prophylaxis of toxoplasmic encephalitis in patients infected with human immunodeficiency virus: open study. Clin. Infect. Dis. 18 (1994) 479–480.
Carr, A., Tindall, B., Brew, B. J., Marriott, D. J., Harkness, J. L., Penny, R., Cooper, D. A. Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS. Ann. Int. Med. 117 (1992) 106–111.
deGans, J., Portegies, P., Reiss, P., Troost, D., vanGool, T., Lange, J. M. A. Pyrimethamine alone as maintenance therapy for central nervous system toxoplasmosis in 38 patients with AIDS. J. Acquir. Immune Defic. Syndr. 5 (1992) 137–142.
Jacobson, M. A., Besch, C. L., Child, C., Hafner, R., Matts, J. P., Muth, K., Wentworth, D. N., Neaton, J. D., Abrams, D., Rimland, D., Perez, G., Grant, L. H., Saravolatz, L. D., Brown, L. S., Deyton, L. andthe Terry Beirn Community Programs for Clinical Research on AIDS Primary prophylaxis with pyrimethamine for toxoplasmic encephalitis in patients with advanced human immunodeficiency virus disease: results of a randomized trial. J. Infect. Dis. 169 (1994) 384–394.
Zangerle, R., Allerberger, F., Pohl, P., Fritsch, P., Dierich, M. P. High risk of developing toxoplasmic encephalitis in AIDS patients seropositive toToxoplasma gondii. Med. Microbiol. Immunol. 180 (1991) 59–66.
Eliaszewicz, M., Lecomte, I., DeSa, M., East Parisian CISIH Group: Relation between decreasing seric CD4 lymphocyte count and outcome of toxoplasmosis in AIDS patients: a basis for primary prophylaxis. VI International Conference on AIDS, San Francisco, 1990, abstr. Th. B. 481.
Hardy, D., Holzman, R., Feinberg, J., Finklestein, D.: Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for secondary prophylaxis ofPneumocystis carinii pneumonia in AIDS patients: a prospective, randomized, controlled clinical trial. Third European Conference on Clinical Aspects and Treatment of HIV Infection, Paris, 1992, abstr. 018.
Tocchetti, A., Tambini, R., Allegro, A., Longoni, E., Rinaldi, E. Four different regimens for prevention ofPneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. AIDS 8 (1994) 272–274.
Leport, C., Raffi, R., Matheron, S., Katlama, C., Regnier, B., Saimot, A. G., Marche, C., Vedrenne, C., Vildé, J. L. Treatment of central nervous system toxoplasmosis with pyrimethamine-sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Efficacy of long-term continuous treatment. Am. J. Med. 84 (1988) 94–110.
Ruf, B., Schürmann, D., Bergmann, F., Schüler-Maué, W., Grünewald, T., Gottschalk, H. S., Witt, H., Pohle, H. D. Efficacy of pyrimethamine/sulfadoxine in the prevention of toxoplasmic encephalitis andPneumocystis carinii pneumonia in HIV-infected patients. Eur. J. Clin. Microbiol. Infect. Dis. 12 (1993) 325–329.
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Klinker, H., Langmann, P. & Richter, E. Pyrimethamine alone as prophylaxis for cerebral toxoplasmosis in patients with advanced HIV infection. Infection 24, 324–327 (1996). https://doi.org/10.1007/BF01743370
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DOI: https://doi.org/10.1007/BF01743370