Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico.
Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico.
Infection. 2018 Feb;46(1):25-30. doi: 10.1007/s15010-017-1059-3. Epub 2017 Aug 16.
Cryptococcal meningitis is a potentially fatal fungal infection associated with a significant attributable morbidity and mortality, especially among HIV/AIDS patients. The first-line therapy for the treatment of this clinical entity is the combinatory therapy of amphotericin B plus flucytosine. However, the high cost, toxic effects, and limited repertoire of effective antifungal drugs have led to the investigation of novel molecules. This is a prospective, double-blinded, and randomized study performed in a Mexican tertiary care center to evaluate the antifungal activity of sertraline in the treatment of cryptococcal meningitis in HIV patients.
During June 2015-December 2016, patients were recruited and included in one of two study groups: group A was given standard antifungal treatment plus sertraline 200 mg/day, while group B was given standard antifungal plus placebo. Lumbar punctures were performed on days 0, 7, and 14 of the study, and cryptococcal antigenemia and quantitative fungal culture in cerebrospinal fluid at each time point were evaluated to measure the rate of fungal clearance.
The fungal loads and cryptococcal antigenemia titers showed a marked tendency to decrease by day 14 in both groups. Otherwise, group B exhibited a slightly higher nonstatistical rate of fungal clearance (-0.2868 ± 0.08275 log CFU/ml/day) than group A (-0.2496 ± 0.08340 log CFU/ml/day).
A statistical difference between study groups was not found. This is the first study in Latin America that reports the experience of using sertraline as an adjuvant in the antifungal management of cryptococcal meningitis in HIV patients.
隐球菌性脑膜炎是一种潜在致命的真菌感染，与较高的发病率和死亡率密切相关，尤其是在 HIV/AIDS 患者中。该临床疾病的一线治疗方案是两性霉素 B 联合氟胞嘧啶的联合治疗。然而，由于高昂的成本、毒性作用以及有限的有效抗真菌药物，促使人们开始研究新型分子。这是一项在墨西哥三级护理中心进行的前瞻性、双盲、随机研究，旨在评估舍曲林在治疗 HIV 患者隐球菌性脑膜炎中的抗真菌活性。
在 2015 年 6 月至 2016 年 12 月期间，招募了患者并将其纳入两个研究组之一：A 组接受标准抗真菌治疗加舍曲林 200mg/天，B 组接受标准抗真菌治疗加安慰剂。在研究的第 0、7 和 14 天进行腰椎穿刺，并在每个时间点评估隐球菌抗原血症和脑脊液定量真菌培养，以测量真菌清除率。
两组的真菌负荷和隐球菌抗原血症滴度在第 14 天均呈明显下降趋势。然而，B 组的真菌清除率略高于 A 组（-0.2868±0.08275 log CFU/ml/天对-0.2496±0.08340 log CFU/ml/天），但无统计学差异。
未发现研究组之间存在统计学差异。这是拉丁美洲第一项报告使用舍曲林作为 HIV 患者隐球菌性脑膜炎抗真菌治疗辅助药物的经验的研究。
