Torres R A, Barr M, Thorn M, Gregory G, Kiely S, Chanin E, Carlo C, Martin M, Thornton J
Department of Medicine St. Vincent's Hospital, New York, New York 10011.
Am J Med. 1993 Dec;95(6):573-83. doi: 10.1016/0002-9343(93)90352-p.
Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis are the most frequent pulmonary and central nervous system opportunistic infections associated with human immunodeficiency virus (HIV) infection. We designed a prospective study to compare the effects of aerosolized pentamidine and dapsone in the prophylaxis of these infections in HIV-infected persons with CD4+ lymphocyte counts less than 250/mm3.
Two hundred seventy-eight patients seropositive for HIV who had acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were randomly assigned to receive intermittent dapsone (100 mg twice weekly) or aerosolized pentamidine (100 mg every 2 weeks). The proportion of patients remaining free of PCP or toxoplasmosis was analyzed with the log-rank test as a function of time, as were the effects of zidovudine or prophylaxis on survival.
Dapsone and aerosolized pentamidine demonstrated similar efficacy in the primary and secondary prophylaxis of PCP, with 15 (18%) failures among patients receiving dapsone compared to 15 (14%) among those receiving aerosolized pentamidine (p = 0.4), after a mean length of follow-up of 42 and 44 weeks, respectively. Dapsone was more effective in the primary prophylaxis of toxoplasmic encephalitis, with six toxoplasmic encephalitis events occurring among those receiving aerosolized pentamidine, compared to none among those taking dapsone (p = 0.01). Primary prophylaxis for PCP was more effective than secondary prophylaxis with either therapy. Zidovudine therapy did not prevent PCP yet prolonged the PCP-free interval for those in whom either prophylactic therapy failed. Kaplan-Meier estimates did not show a difference in survival between the patients receiving either therapy, yet zidovudine use was associated with improved survival, independent of race and risk factor (Cox proportional hazards model, p = 0.001). The 1-month survival for patients developing PCP despite prophylaxis was better with those in whom dapsone failed than it was for those in whom aerosolized pentamidine failed (p = 0.08).
Dapsone is as effective as aerosolized pentamidine in preventing PCP and has the advantage of a lower cost, easier administration, and possibly an additional preventive effect against toxoplasmosis. Zidovudine prolongs the PCP-free interval for patients receiving prophylaxis, regardless of which prophylactic agent is used.
卡氏肺孢子虫肺炎（PCP）和弓形虫性脑炎是与人类免疫缺陷病毒（HIV）感染相关的最常见的肺部和中枢神经系统机会性感染。我们设计了一项前瞻性研究，以比较雾化喷他脒和氨苯砜对CD4 +淋巴细胞计数低于250/mm³的HIV感染者预防这些感染的效果。
278例血清HIV阳性且患有获得性免疫缺陷综合征（AIDS）或晚期AIDS相关综合征的患者被随机分配接受间歇性氨苯砜（每周两次，每次100mg）或雾化喷他脒（每2周100mg）。采用对数秩检验分析无PCP或弓形虫病患者的比例随时间的变化情况，以及齐多夫定或预防措施对生存的影响。
氨苯砜和雾化喷他脒在PCP的一级和二级预防中显示出相似的疗效，接受氨苯砜治疗的患者中有15例（18%）预防失败，接受雾化喷他脒治疗的患者中有15例（14%）预防失败（p = 0.4），平均随访时间分别为42周和44周。氨苯砜在弓形虫性脑炎的一级预防中更有效，接受雾化喷他脒治疗的患者中有6例发生弓形虫性脑炎，而服用氨苯砜的患者中无1例发生（p = 0.01）。PCP的一级预防比两种治疗方法中的任何一种二级预防都更有效。齐多夫定治疗不能预防PCP，但可延长预防治疗失败患者的无PCP间隔时间。Kaplan-Meier估计显示两种治疗方法的患者生存率无差异，但使用齐多夫定与生存率提高相关，与种族和危险因素无关（Cox比例风险模型，p = 0.001）。尽管进行了预防，但发生PCP的患者中，氨苯砜预防失败的患者1个月生存率高于雾化喷他脒预防失败的患者（p = 0.08）。
氨苯砜在预防PCP方面与雾化喷他脒同样有效，且具有成本更低、给药更方便以及可能对弓形虫病有额外预防作用的优点。齐多夫定可延长接受预防治疗患者的无PCP间隔时间，无论使用哪种预防药物。
