Possible effectiveness of clarithromycin and rifabutin for cryptosporidiosis chemoprophylaxis in HIV disease. HIV Outpatient Study (HOPS) Investigators

JAMA. 1998 Feb 4;279(5):384-6. doi: 10.1001/jama.279.5.384.

Abstract

Context: Cryptosporidium parvum infection, a common cause of diarrhea in persons infected with the human immunodeficiency virus (HIV), is difficult to treat or prevent.

Objective: To evaluate relative rates of cryptosporidiosis in HIV-infected patients who were either receiving or not receiving chemoprophylaxis or treatment for Mycobacterium avium complex.

Design: Analysis of prospectively collected data from HIV-infected patients' visits to their physicians since 1992.

Setting: Ten (8 private, 2 publicly funded) HIV clinics in 9 US cities.

Patients: A total of 1019 HIV-infected patients with CD4+ cell counts less than 0.075 x 10(9)/L.

Main outcome measures: Incidence of clinical cryptosporidiosis during treatment with clarithromycin, rifabutin, and azithromycin.

Results: Five of the 312 patients reportedly taking clarithromycin developed cryptosporidiosis vs 30 of the 707 patients not taking clarithromycin (relative hazard [RH], 0.25 [95% confidence interval (CI), 0.10-0.67]; P=.004). Two of the 214 patients taking rifabutin developed cryptosporidiosis vs 33 of the 805 not taking rifabutin (RH, 0.15 [95% CI, 0.04-0.62]; P=.01). Prophylactic efficacy of either drug was 75% or greater. No protective effect was seen in the 54 patients reportedly taking azithromycin (RH, 1.48 [95% CI, 0.44-5.04]; P=.46).

Conclusions: Clarithromycin and rifabutin were highly protective against development of cryptosporidiosis in immune-suppressed HIV-infected persons in this analysis; further study is warranted.

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control*
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotics, Antitubercular / therapeutic use*
  • Azithromycin / therapeutic use
  • Clarithromycin / therapeutic use*
  • Cryptosporidiosis / prevention & control*
  • Female
  • HIV Infections / drug therapy*
  • Humans
  • Likelihood Functions
  • Male
  • Prospective Studies
  • Rifabutin / therapeutic use*
  • Statistics, Nonparametric

Substances

  • Anti-Bacterial Agents
  • Antibiotics, Antitubercular
  • Rifabutin
  • Azithromycin
  • Clarithromycin