Abstract | OBJECTIVES:
Rifabutin prophylaxis has been shown to significantly decrease the incidence of Mycobacterium avium complex (MAC) bacteremia in two randomized controlled clinical trials, but a survival benefit has not been observed. An analysis of complete follow-up of these patients through August 1992 was performed to assess subsequent survival, because although follow-up in the previous trials was limited at the time of initial analysis, the analysis did suggest that a survival benefit might be emerging. METHODS: Data from 1146 AIDS patients with CD4+ counts < or = 200 x 10(6)/l enrolled at 73 US and Canadian sites in two clinical trials of MAC prophylaxis were analyzed using Cox proportional hazards analysis with rifabutin use modeled as a time-dependent covariate, taking into account the initial randomized double-blind phase of the trials and the subsequent open-label phase of follow-up of those patients. Survival from date of enrollment was analyzed. Other covariates adjusted for in the analysis were CD4+ lymphocytes count, Karnofsky performance score and hospitalization for opportunistic complications of AIDS. RESULTS: Patients who received open-label rifabutin may have had a better prognosis than those who did not, based on Karnofsky score and occurrence of opportunistic disease. Adjusting for these variables and for use of rifabutin as time-dependent covariates, the relative hazard (RH) of dying while receiving rifabutin prophylaxis was 0.74 for the entire cohort [95% confidence interval (CI), 0.60-0.91; P < 0.004]. For patients with an enrollment CD4+ count < or = 50 x 10(6)/l (n = 655), the RH was 0.75 (95% CI, 0.58-0.98), and for patients with an enrollment CD4+ count of > 50 x 10(6)/l (n = 491), the RH was 0.69 (95% CI, 0.49-0.99). CONCLUSIONS: An analysis of the combined double-blind and open-label follow-up of two clinical trials of rifabutin prophylaxis for MAC supports the suggestion of the double-blind study that rifabutin improves survival of AIDS patients.
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Authors | R D Moore, R E Chaisson |
Journal | AIDS (London, England)
(AIDS)
Vol. 9
Issue 12
Pg. 1337-42
(Dec 1995)
ISSN: 0269-9370 [Print] England |
PMID | 8605053
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibiotics, Antitubercular
- Rifabutin
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Topics |
- AIDS-Related Opportunistic Infections
(prevention & control)
- Acquired Immunodeficiency Syndrome
(complications, mortality)
- Adult
- Antibiotics, Antitubercular
(therapeutic use)
- Bacteremia
(complications, mortality, prevention & control)
- Double-Blind Method
- Female
- Follow-Up Studies
- Humans
- Karnofsky Performance Status
- Male
- Middle Aged
- Mycobacterium avium Complex
(drug effects)
- Proportional Hazards Models
- Rifabutin
(therapeutic use)
- Survival Analysis
- Tuberculosis
(complications, mortality, prevention & control)
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