Further reassurance on the question of when to stop maintenance treatment to prevent recurrences of opportunistic infections came today at the Seventh Conference on Retroviruses and Opportunistic Infections in San Francisco.
Spanish researchers reported no new cases of toxoplasmosis in individuals who stopped maintenance or primary prophylaxis after experiencing sustained CD4 increases to above 200 cells/mm3. They followed 302 patients for a median of ten months (Miro)
Swiss researchers saw similar results in 381 patients with CD4 counts increases above 200 cells/mm3 who discontinued co-trimoxazole PCP prophylaxis (which also protects against toxoplasmosis). No cases of primary toxoplasmosis lesions occurred in this group, after approximately 16 months despite the fact that 47% were toxoplasmosis positive.
US researchers reported that six individuals who had been receiving fluconazole maintenance treatment after an episode of disseminated cryptococcosis were able to stop the treatment without experiencing relapse when their CD4 counts had increased above 150 cells/mm3 on HAART. However, follow up on these individuals was only eight weeks, and further follow-up will be required (Aberg).
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References
Aberg J et al. Discontinuation of antifungal therapy for cryptococcosis after immunologic response to antiretroviral thearpy. Abstract 250, Seventh Conference on Retroviruses, San Francisco, 2000
Furrer H et al. The Swiss StopCox study: is it safe to discontinue PCP prophylaxis in patients with detectable viremia, low nadir CD4 count or T.gondii seropositivity? Abstract 244, Seventh Conference on Retroviruses, San Francisco, 2000.
Miro J et al. Discontinuation of toxoplasmic encephalitis prophylaxis is safe in HIV-1 and T-gondii coinfected patients after immunological recovery with HAART: preliminary results of the GESIDA 04/98-B study. Abstract 230, Seventh Conference on Retroviruses, San Francisco, 2000.