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1996-03-04
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Document 0808
DOCN M9640808
TI Prospects for preventing cryptococcosis in persons infected with human
immunodeficiency virus.
DT 9604
AU Pinner RW; Hajjeh RA; Powderly WG; National Center for Infectious
Diseases, Centers for Disease; Control and Prevention, Atlanta, Georgia
30333, USA.
SO Clin Infect Dis. 1995 Aug;21 Suppl 1:S103-7. Unique Identifier :
AIDSLINE MED/96002836
AB Cryptococcosis is a major cause of illness and death among persons
infected with human immunodeficiency virus (HIV). Its management must
include both initial and maintenance treatment. Although most
authorities favor an initial period of therapy with amphotericin B for
acute cryptococcosis, the triazoles play a role in both the management
of acute disease and subsequent maintenance therapy. AIDS surveillance
data collected by the Centers for Disease Control and Prevention
document the occurrence of cryptococcosis in more than 17,000 (6.2%) of
adults with AIDS in the United States, although this figure is known to
be an underestimate. The risk of cryptococcosis among HIV-infected
persons is highest at CD4+ lymphocyte counts of < 100/microL. Although
cryptococcosis is especially frequent among AIDS patients who are black,
male, or injection drug users, the explanations for these patterns
remain unclear. Whether geographic differences in rates of
cryptococcosis result from variations in the environmental distribution
of Cryptococcus neoformans as well as in the distribution of HIV
infection is also unclear. Although exposure to pigeon feces is the best
known of the putative exposure-related risk factors, proof is lacking
that avian excreta are the primary environmental source of the organism
in most cases of cryptococcosis. Prophylaxis with triazoles can prevent
cryptococcosis and may be considered for adults and adolescents with
CD4+ counts of < 50/microL. However, it is uncertain whether prophylaxis
will affect survival, be cost-effective, or have an adverse impact on
the susceptibility of a variety of fungi to antifungal drugs. Vaccines
and monoclonal antibodies designed to prevent or modify cryptococcosis
in HIV-infected persons are in the experimental stage.
DE Adult Amphotericin B/THERAPEUTIC USE
Cryptococcosis/EPIDEMIOLOGY/*PREVENTION & CONTROL Female Human HIV
Infections/*COMPLICATIONS Incidence Male Risk Factors United
States/EPIDEMIOLOGY JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).