Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy
Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy
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DOI：
10.1086/420749
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发表时间：
2004-05-15
影响因子：
11.8
通讯作者：
Aberg, JA
中科院分区：
文献类型：
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作者：
Goldman, M;Zackin, R;Aberg, JA
我们进行了一项前瞻性观察性研究，以评估人类免疫缺陷病毒感染患者在抗逆转录病毒治疗后停止播散性组织胞浆菌病维持治疗的安全性。所有受试者在入组前均接受至少 12 个月的抗真菌治疗和 6 个月的抗逆转录病毒治疗。真菌血培养、尿液和血清组织胞浆菌抗原水平为 150 个细胞/mm(3) 的阴性结果才符合资格。注册了 32 名受试者；研究开始时CD4(+) T细胞计数中位数为289个细胞/mm(3)。中位随访时间 24 个月后，没有发生组织胞浆菌病复发。这相当于每 65 人年观察到的复发率为 0 例。最终研究访视时的中位 CD4(+) T 细胞计数为 338 个细胞/mm(3)。对于既往接受过播散性组织胞浆菌病治疗且抗逆转录病毒治疗后免疫功能持续改善的获得性免疫缺陷综合征患者，停止抗真菌维持治疗似乎是安全的。
We performed a prospective observational study to assess the safety of stopping maintenance therapy for disseminated histoplasmosis among human immunodeficiency virus - infected patients after response to antiretroviral therapy. All subjects received at least 12 months of antifungal therapy and 6 months of antiretroviral therapy before entry. Negative results of fungal blood cultures, urine and serum Histoplasma antigen level of 150 cells/mm(3) were required for eligibility. Thirty-two subjects were enrolled; the median CD4(+) T cell count at study entry was 289 cells/mm(3). No relapses of histoplasmosis occurred after a median duration of follow-up of 24 months. This corresponded to an observed relapse rate of 0 cases per 65 person-years. The median CD4(+) T cell count at final study visit was 338 cells/mm(3). Discontinuation of antifungal maintenance therapy appears to be safe for patients with acquired immunodeficiency syndrome with previously treated disseminated histoplasmosis and sustained immunologic improvement in response to antiretroviral therapy.