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
Department of Medicine, University of California, San Francisco.
J Infect Dis. 1994 Feb;169(2):384-94. doi: 10.1093/infdis/169.2.384.
Pyrimethamine, 25 mg thrice weekly, was evaluated as primary prophylaxis for toxoplasmic encephalitis (TE) in a double-blind, randomized clinical trial in patients with human immunodeficiency virus (HIV) disease, absolute CD4 lymphocyte count of < 200/microL (or prior AIDS-defining opportunistic infection), and the presence of serum IgG to Toxoplasma gondii. Leucovorin was coadministered only for hematologic toxicity. There was a significantly higher death rate among patients receiving pyrimethamine (relative risk [RR], 2.5; 95% confidence interval [CI], 1.3-4.8; P = .006), even after adjusting for factors predictive of survival. The TE event rate was low in both treatment groups (not significant). Only 1 of 218 patients taking trimethoprim-sulfamethoxazole but 7 of 117 taking aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia developed TE (adjusted RR for the trimethoprim-sulfamethoxazole group, 0.16; 95% CI, 0.01-1.79; P = .14). Thus, for HIV-infected patients receiving trimethoprim-sulfamethoxazole, additional prophylaxis for TE appears unnecessary.
在一项针对人类免疫缺陷病毒（HIV）感染者、绝对CD4淋巴细胞计数<200/微升（或既往有艾滋病定义的机会性感染）且血清抗弓形虫IgG阳性患者的双盲随机临床试验中，评估了每周三次服用25毫克乙胺嘧啶作为弓形虫性脑炎（TE）的一级预防措施。仅在出现血液学毒性时才联合使用亚叶酸钙。即使在对生存预测因素进行调整后，接受乙胺嘧啶治疗的患者死亡率仍显著更高（相对风险[RR]，2.5；95%置信区间[CI]，1.3 - 4.8；P = 0.006）。两个治疗组的TE事件发生率均较低（无显著性差异）。在218名服用甲氧苄啶 - 磺胺甲恶唑预防卡氏肺孢子虫肺炎的患者中，只有1例发生TE，而在117名服用雾化戊烷脒预防卡氏肺孢子虫肺炎的患者中有7例发生TE（甲氧苄啶 - 磺胺甲恶唑组的调整RR为0.16；95% CI，0.01 - 1.79；P = 0.14）。因此，对于接受甲氧苄啶 - 磺胺甲恶唑治疗的HIV感染患者，似乎无需额外预防TE。
