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Abstract
Antifungal interventions for the primary prevention of cryptococcal disease in persons with HIV: a systematic review
L W Chang1, W P Phipps1, G E Kennedy2, G W Rutherford2
1University of California, San Francisco, San Francisco, United States; 2Cochrane Collaborative Review Group on HIV Infection and AIDS, San Francisco, United States
Background: Cryptococcal disease is a major source of morbidity and mortality in persons with HIV, particularly in the developing world. In this systematic review, the efficacy of antifungals for the primary prevention of cryptococcal disease in persons with HIV will be assessed.
Methods: We searched for randomised controlled trials of the prophylaxis for cryptococcal disease among persons with HIV infection. Trials were identified through database (MEDLINE, EMBASE, AIDSDRUGS, AIDSLINE, AIDSTRIALS, CINAHL, DARE, and specialized Cochrane registries) and conference abstract searches, as well as inquiries with experts, authors, and pharmaceutical companies. The time period searched was 1982 to January 2004. Articles were reviewed, abstracted, and assessed on methodologic quality. Efficacy was compared using random-effects meta-analysis and computed relative risk ratios with 95% confidence intervals with the primary outcome being cryptococcal disease incidence.
Results: Five randomised controlled trials were identified and included in this study with a total of 1316 participants. The three trials using itraconazole-based interventions were efficacious (RR=0.12, 95% CI=0.03, 0.51, NNT=20), as were the two fluconazole-based intervention trials (RR=0.23, 95% CI=0.09, 0.61, NNT=14). Analysis of overall mortality as a secondary outcome did not find either itraconazole-based (RR=1.12, CI=0.70, 1.80) nor fluconazole-based (RR=0.59, CI=0.14, 2.62) interventions to be efficacious.
Conclusions: Both itraconazole and fluconazole are effective in the primary prevention of cryptococcal disease in adults with HIV. However, neither of these interventions appear to clearly decrease overall mortality.
The XV International AIDS Conference
Abstract no.
B10408
Suggested Citation
" L W Chang , , et al.
Antifungal interventions for the primary prevention of cryptococcal disease in persons with HIV: a systematic review.
CD Only:
The XV International AIDS Conference:
Abstract no.
B10408"
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