Journal Article

Comparison of High and Low Doses of Trimethoprim-Sulfamethoxazole for Primary Prevention of Toxoplasmic Encephalitis in Human Immunodeficiency Virus-Infected Patients

Esteban Ribera, Antoni Fernandez-Sola, Concepcion Juste, Alex Rovira, Francisco J. Romero, Lluis Armadans-Gil, Isabel Ruiz, Imma Ocaña and Albert Pahissa

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 6, pages 1461-1466
Published in print December 1999 | ISSN: 1058-4838
Published online December 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/313515
Comparison of High and Low Doses of Trimethoprim-Sulfamethoxazole for Primary Prevention of Toxoplasmic Encephalitis in Human Immunodeficiency Virus-Infected Patients

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To evaluate the influence of the dose of co-trimoxazole prophylaxis on the risk of toxoplasmosis in human immunodeficiency virus (HIV)-infected patients, we performed a nested case-control study of 32 patients with toxoplasmosis (case patients) and 64 patients without toxoplasmosis (control patients) who were matched by CD4 cell count and Toxoplasma gondii serostatus; these patients were from a cohort of 521 HIV-infected patients who underwent a diagnostic neuroimaging study between March 1993 and January 1997. Twenty-seven (84.4%) of 32 case patients and 33 (51.6%) of 64 control patients received low doses of co-trimoxazole, a finding associated with an adjusted odds ratio (OR) of 9.36 (95% confidence interval [CI], 2.05–42.75) and indicating 89% protective efficacy for high doses. Fifteen (46.9%) of 32 case patients and 16 (25%) of 64 control patients were exposed to rifampin (adjusted OR, 3.38; 95% CI, 1.08–10.61). These results indicate that high doses of co-trimoxazole appear to be more effective than low doses for lowering the risk of toxoplasmosis in HIV-infected patients and that rifampin therapy may reduce the efficacy of co-trimoxazole.

Journal Article.  4126 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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