Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients.

OBJECTIVE

To investigate the efficacy of fluconazole prophylaxis against systemic fungal infections in HIV-positive patients.

DESIGN

Open label treatment compared with historical controls.

SETTING

Patients were seen at the Parkland Memorial Hospital HIV Clinic, Dallas, Texas, USA between 1 March 1990 and 28 February 1991.

PATIENTS, PARTICIPANTS: Three hundred and thirty-seven historical controls were followed for 157 patient-years, and 329 fluconazole-treated patients for 145 patient-years.

INTERVENTIONS

Fluconazole (100 mg daily) was administered to all patients with CD4 lymphocyte counts less than 68 x 10(6)/l seen at our HIV clinic after 1 March 1990.

MAIN OUTCOME MEASURES

Lysis-centrifugation blood cultures were recorded monthly for all patients during both study periods.

RESULTS

Twenty infections (16 cryptococcosis, four histoplasmosis) occurred in 337 historical reference control patients (product-limit 1-year incidence, 7.5 +/- 2.0/year). Four infections (one cryptococcosis, three histoplasmosis) occurred in the treated patient group (product-limit 1-year incidence, 1.8 +/- 0.9/year).

CONCLUSIONS

Fluconazole warrants further evaluation for prophylaxis against systemic fungal infections in HIV-positive patients.