Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand

Background: Disseminated fungal infections are common presenting opportunistic infections among AIDS patients in developing countries. Primary prophylaxis with itraconazole has been shown to be effective in northern Thailand. This study aimed to compare the efficacy of fluconazole vs itraconazole as...

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Main Authors: Romanee Chaiwarith, Apinya Fakthongyoo, Jutarat Praparattanapan, Darakorn Boonmee, Thira Sirisanthana, Khuanchai Supparatpinyo
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/50022
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-500222018-09-04T04:25:33Z Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand Romanee Chaiwarith Apinya Fakthongyoo Jutarat Praparattanapan Darakorn Boonmee Thira Sirisanthana Khuanchai Supparatpinyo Immunology and Microbiology Medicine Background: Disseminated fungal infections are common presenting opportunistic infections among AIDS patients in developing countries. Primary prophylaxis with itraconazole has been shown to be effective in northern Thailand. This study aimed to compare the efficacy of fluconazole vs itraconazole as primary prophylaxis for fungal infections in HIV-infected patients. Methods: A retrospective cohort study was conducted among HIV-infected patients who received primary prophylaxis with fluconazole 400 mg once weekly or itraconazole 200 mg once daily at Chiang Mai University Hospital. We compared the incidence of systemic fungal infections and the probability of disease-free survival between groups. Results: From January 2000 to June 2010, 308 HIV-infected patients who received primary fungal prophylaxis were enrolled; 148 were male (48.1%) and the mean age was 38.2 ± 8.0 years. 276 patients received fluconazole and 32 received itraconazole. Baseline CD4+ cell count was 35 (IQR 15, 70) and 50 (IQR 21,75) cells/mm 3 in fluconazole and itraconazole groups, respectively (p=0.159). The median follow-up time was 12 months (IQR 7, 19) in fluconazole group and 15.5 months (IQR 9, 21.5) in itraconazole group. Seven patients (2.5%) who received fluconazole and 2 patients (6.3%) who received itraconazole developed systemic fungal infections, giving the incidence of 17.0 and 34.8/10000 person-months, respectively (p=0.261). The probability of developing any systemic fungal infections or death did not differ between groups. Conclusions: Although P. marneffei has a reduced susceptibility in in vitro to fluconazole, our study has demonstrated that once-weekly fluconazole is at least as effective as once-daily itraconazole as primary prophylaxis for systemic fungal infections in AIDS patients in northern Thailand. © 2011 Bentham Science Publishers. 2018-09-04T04:22:09Z 2018-09-04T04:22:09Z 2011-10-17 Journal 18734251 1570162X 2-s2.0-80053949888 10.2174/157016211797635991 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=80053949888&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/50022
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Immunology and Microbiology
Medicine
spellingShingle Immunology and Microbiology
Medicine
Romanee Chaiwarith
Apinya Fakthongyoo
Jutarat Praparattanapan
Darakorn Boonmee
Thira Sirisanthana
Khuanchai Supparatpinyo
Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
description Background: Disseminated fungal infections are common presenting opportunistic infections among AIDS patients in developing countries. Primary prophylaxis with itraconazole has been shown to be effective in northern Thailand. This study aimed to compare the efficacy of fluconazole vs itraconazole as primary prophylaxis for fungal infections in HIV-infected patients. Methods: A retrospective cohort study was conducted among HIV-infected patients who received primary prophylaxis with fluconazole 400 mg once weekly or itraconazole 200 mg once daily at Chiang Mai University Hospital. We compared the incidence of systemic fungal infections and the probability of disease-free survival between groups. Results: From January 2000 to June 2010, 308 HIV-infected patients who received primary fungal prophylaxis were enrolled; 148 were male (48.1%) and the mean age was 38.2 ± 8.0 years. 276 patients received fluconazole and 32 received itraconazole. Baseline CD4+ cell count was 35 (IQR 15, 70) and 50 (IQR 21,75) cells/mm 3 in fluconazole and itraconazole groups, respectively (p=0.159). The median follow-up time was 12 months (IQR 7, 19) in fluconazole group and 15.5 months (IQR 9, 21.5) in itraconazole group. Seven patients (2.5%) who received fluconazole and 2 patients (6.3%) who received itraconazole developed systemic fungal infections, giving the incidence of 17.0 and 34.8/10000 person-months, respectively (p=0.261). The probability of developing any systemic fungal infections or death did not differ between groups. Conclusions: Although P. marneffei has a reduced susceptibility in in vitro to fluconazole, our study has demonstrated that once-weekly fluconazole is at least as effective as once-daily itraconazole as primary prophylaxis for systemic fungal infections in AIDS patients in northern Thailand. © 2011 Bentham Science Publishers.
format Journal
author Romanee Chaiwarith
Apinya Fakthongyoo
Jutarat Praparattanapan
Darakorn Boonmee
Thira Sirisanthana
Khuanchai Supparatpinyo
author_facet Romanee Chaiwarith
Apinya Fakthongyoo
Jutarat Praparattanapan
Darakorn Boonmee
Thira Sirisanthana
Khuanchai Supparatpinyo
author_sort Romanee Chaiwarith
title Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
title_short Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
title_full Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
title_fullStr Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
title_full_unstemmed Itraconazole vs fluconazole as a primary prophylaxis for fungal infections in HIV-infected patients in Thailand
title_sort itraconazole vs fluconazole as a primary prophylaxis for fungal infections in hiv-infected patients in thailand
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=80053949888&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/50022
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