Long-term amphotericin B therapy for disseminated histoplasmosis in patients with the acquired immunodeficiency syndrome (AIDS)

• Published in: Annals of internal medicine Vol. 111; no. 8; p. 655
• Main Authors: McKinsey, D S, Gupta, M R, Riddler, S A, Driks, M R, Smith, D L, Kurtin, P J
• Format: Journal Article
• Language: English
• Published: United States 15.10.1989
• Subjects: Acquired Immunodeficiency Syndrome - complications; Adult; Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Catheters, Indwelling - adverse effects; Drug Administration Schedule; Female; Histoplasmosis - drug therapy; Histoplasmosis - etiology; Humans; Male; Middle Aged; Opportunistic Infections - drug therapy; Opportunistic Infections - etiology; Pilot Projects; Recurrence
• ISSN: 0003-4819
• DOI: 10.7326/0003-4819-111-8-655

To assess the efficacy and toxicity of long-term maintenance amphotericin B therapy in preventing relapses after treatment in patients with the acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis. Open, nonrandomized pilot study. Three private, university-affiliated community hospitals. We studied 22 consecutive patients with disseminated histoplasmosis and human immunodeficiency virus (HIV) infection. Sixteen patients completed the study, 5 patients died before completing the initial intensive phase of treatment, and 1 patient received a different treatment regimen. Seven patients were treated with an initial intensive course of 1000 mg of amphotericin B, followed by weekly infusions of 50 to 80 mg until a cumulative dose of 2000 mg was attained; biweekly infusions of 50 to 80 mg were then continued indefinitely. Nine patients received an initial amphotericin B course of 2000 mg followed by weekly infusions of 80 mg. Of the 7 patients in the 1000-mg intensive regimen group, 6 patients have survived without clinical or laboratory evidence of a histoplasmosis relapse, and 1 died of unrelated causes. Of the 9 patients in the 2000-mg intensive regimen group, 7 patients have survived, 1 patient died of a histoplasmosis relapse, and 1 patient died of other causes. Thus, 13 of 14 patients (93%) who did not die of other causes remained relapse-free. The median follow-up period was 14 months (range, 2 to 23 months). No apparent differences in outcome were observed between patients treated with weekly maintenance regimens and those treated with biweekly maintenance regimens. Sixty-three percent of patients developed intravascular device-related complications. Long-term, intermittent maintenance amphotericin B therapy in HIV-infected patients with disseminated histoplasmosis is well tolerated and is highly effective in suppressing relapses after treatment.