Brossard G, Neau D, Barbeau P, Pellegrin J L, Leng B
Clinique de Médecine interne et Maladies infectieuses, Hôpital Haut Lévêque (CHU de Bordeaux), Pessac.
Presse Med. 1994 Apr 2;23(13):613-5.
Cerebral toxoplasmosis is the most frequent opportunistic infection in patients with acquired immune deficiency syndrome in France. We evaluated the effect of adding folic acid to the standard treatment (including pyrimethamine) on preventing induced cytopenia in order to determine the optimal dose.
From January to September 1990, pyrimethamine (50 mg 3 times per week) was given as primary prophylaxis against toxoplasmosis to 30 patients who were positive for human immunodeficiency virus (CDC classes II or II, CD4 counts < 200/mm3). The patients were randomly divided into three groups given 5, 25 and 0 mg folic acid 3 times per week. Associated treatments were the same in all patients (zidovudine 600 mg/d, pentamidine isethionate aerosol, 300 mg, once a month). Blood cell counts and lymphocyte subset counts were made on days 0, 30, 90 and 180.
Two patients were lost to follow-up and between day 90 and 180, 3 were excluded due to other opportunist infection and 1 due to zidovudine induced anaemia. Between the groups, there was no difference in haemoglobin level or cell counts on day 0. No haematologic toxicity was observed at day 90. Haemoglobin was significantly reduced in the control group (0 mg folic acid) on day 180 (mean haemoglobin on day 180, 13.8, 13.1 and 12.1 g/dl in groups 1, 2 and 3 respectively). No variation in polynuclear neutrophil counts was observed.
These findings suggest that folic acid has a moderate beneficial effect on preventing haematologic disease in patients treated with pyrimethamine. There was no observed dose effect.
脑弓形虫病是法国获得性免疫缺陷综合征患者中最常见的机会性感染。我们评估了在标准治疗（包括乙胺嘧啶）中添加叶酸对预防诱导性血细胞减少的效果，以确定最佳剂量。
1990年1月至9月，对30名人类免疫缺陷病毒检测呈阳性（疾病控制与预防中心II或III级，CD4计数<200/mm³）的患者给予乙胺嘧啶（每周3次，每次50毫克）作为弓形虫病的一级预防。患者被随机分为三组，分别每周3次给予5毫克、25毫克和0毫克叶酸。所有患者的联合治疗相同（齐多夫定600毫克/天，每月1次喷他脒气雾剂300毫克）。在第0、30、90和180天进行血细胞计数和淋巴细胞亚群计数。
2名患者失访，在第90天至180天之间，3名患者因其他机会性感染被排除，1名患者因齐多夫定诱导的贫血被排除。各组之间，第0天的血红蛋白水平或细胞计数无差异。第90天未观察到血液学毒性。在第180天，对照组（0毫克叶酸）的血红蛋白显著降低（第180天第1、2和3组的平均血红蛋白分别为13.8、13.1和12.1克/分升）。未观察到多形核中性粒细胞计数的变化。
这些发现表明，叶酸对预防接受乙胺嘧啶治疗患者的血液学疾病有中度有益作用。未观察到剂量效应。
