Bucher H C, Griffith L, Guyatt G H, Opravil M
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Jun 1;15(2):104-14. doi: 10.1097/00042560-199706010-00002.
In a meta-analysis, we examined the efficacy of aerosolized pentamidine, trimethoprim-sulfamethoxazole, and dapsone or dapsone/pyrimethamine for the prevention of Pneumocystis carinii pneumonia and toxoplasma encephalitis in patients with HIV infection. Of 22 trials, 13 compared trimethoprim-sulfamethoxazole with aerosolized pentamidine, nine compared dapsone alone or in combination with pyrimethamine with aerosolized pentamidine, and eight compared trimethoprim-sulfamethoxazole with dapsone/pyrimethamine. In total, 1484 patients were treated with trimethoprim-sulfamethoxazole, 1548 patients with dapsone/pyrimethamine or dapsone, and 1800 patients with aerosolized pentamidine. For dapsone/pyrimethamine versus aerosolized pentamidine, the risk ratio for P. carinii pneumonia was 0.90 (95% confidence interval [CI], 0.71-1.15), and for toxoplasma encephalitis it was 0.72 (95% CI, 0.54-0.97). For trimethoprim-sulfamethoxazole versus aerosolized pentamidine, the risk ratio of P. carinii pneumonia was 0.59 (95% CI, 0.45-0.76), and for toxoplasma encephalitis it was 0.78 (95% CI, 0.55-1.11). For trimethoprim-sulfamethoxazole versus dapsone/pyrimethamine, the risk ratio of P. carinii pneumonia was 0.49 (95% CI, 0.26-0.92), and for toxoplasma encephalitis it was 1.17 (95% CI, 0.68-2.04). Although current evidence does not allow a definitive recommendation, administration of trimethoprim-sulfamethoxazole for prophylaxis of P. carinii pneumonia and toxoplasmosis in patients with HIV infection is consistent with the available data.
在一项荟萃分析中，我们研究了雾化喷他脒、甲氧苄啶 - 磺胺甲恶唑以及氨苯砜或氨苯砜/乙胺嘧啶在预防HIV感染患者卡氏肺孢子虫肺炎和弓形虫性脑炎方面的疗效。在22项试验中，13项比较了甲氧苄啶 - 磺胺甲恶唑与雾化喷他脒，9项比较了单独使用氨苯砜或氨苯砜与乙胺嘧啶联用和雾化喷他脒，8项比较了甲氧苄啶 - 磺胺甲恶唑与氨苯砜/乙胺嘧啶。总共有1484例患者接受了甲氧苄啶 - 磺胺甲恶唑治疗，1548例患者接受了氨苯砜/乙胺嘧啶或氨苯砜治疗，1800例患者接受了雾化喷他脒治疗。对于氨苯砜/乙胺嘧啶与雾化喷他脒，卡氏肺孢子虫肺炎的风险比为0.90（95%置信区间[CI]，0.71 - 1.15），弓形虫性脑炎的风险比为0.72（95%CI，0.54 - 0.97）。对于甲氧苄啶 - 磺胺甲恶唑与雾化喷他脒，卡氏肺孢子虫肺炎的风险比为0.59（95%CI，0.45 - 0.76），弓形虫性脑炎的风险比为0.78（95%CI，0.55 - 1.11）。对于甲氧苄啶 - 磺胺甲恶唑与氨苯砜/乙胺嘧啶，卡氏肺孢子虫肺炎的风险比为0.49（95%CI，0.26 - 0.92），弓形虫性脑炎的风险比为1.17（95%CI，0.68 - 2.04）。尽管目前的证据尚不允许做出明确推荐，但在HIV感染患者中使用甲氧苄啶 - 磺胺甲恶唑预防卡氏肺孢子虫肺炎和弓形虫病与现有数据一致。
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