Rifabutin but not clarithromycin prevents cryptosporidiosis in persons with advanced HIV infection.

Abstract

BACKGROUND:

Macrolides have been reported to be effective for the prevention of cryptosporidiosis in persons with HIV infection.

OBJECTIVE:

To evaluate the efficacy of clarithromycin and rifabutin for the prevention of cryptosporidiosis in persons with advanced HIV infection.

DESIGN:

Cross-protocol analysis involving 2288 individuals with a history of a CD4 cell counts of < or = 100 x 10(6) cell/l who were enrolled in two prospective clinical trials to prevent Mycobacterium avium complex (MAC) infection and cytomegalovirus (CMV) end-organ disease.

INTERVENTIONS:

Clarithromycin 500 mg twice daily, rifabutin 300-450 mg daily, the combination of the two or no MAC prophylaxis.

MAIN OUTCOME MEASUREMENT:

Laboratory-confirmed cryptosporidiosis. Subjects were analyzed in an intent-to-treat and as-treated manner using time-to-event analyses (Cox proportional hazards models).

RESULTS:

The median length of follow up was 463 days. The median CD4 count at entry was 29 x 10(6) cell/l (range 0-182). There were 60 cases of cryptosporidiosis during the prospective observational period, with an event rate of 2.2 per 100 person-years. In the intent-to-treat [relative risk (RR) 0.50; 95% confidence interval (CI) 0.26-0.96; P = 0.041 and as-treated (RR 0.42; 95% CI 0.20-0.91; P = 0.03) analyses, rifabutin alone was significantly associated with a lower rate of cryptosporidiosis. Clarithromycin alone was not protective in similar analyses (P = 0.98 and 0.90, respectively).

CONCLUSIONS:

In doses used to prevent MAC infection, rifabutin but not clarithromycin decreases the risk of developing cryptosporidiosis in persons with advanced HIV infection who are not receiving potent combination antiretroviral therapy.

• Authors: C J Fichtenbaum, R Zackin, J Feinberg, C Benson, J K Griffiths, AIDS Clinical Trials Group New Works Concept Sheet Team 064
• Journal: AIDS (London, England) (AIDS) Vol. 14 Issue 18 Pg. 2889-93 (Dec 22 2000) ISSN: 0269-9370 [Print] England
• PMID: 11153670 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Bacterial Agents
• Rifabutin
• Clarithromycin

Topics

• AIDS-Related Opportunistic Infections (prevention & control)
• Adolescent
• Adult
• Aged
• Animals
• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Child
• Clarithromycin (therapeutic use)
• Cryptosporidiosis (prevention & control)
• Cryptosporidium parvum
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Mycobacterium avium Complex
• Mycobacterium avium-intracellulare Infection (prevention & control)
• Rifabutin (therapeutic use)