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document
Primary prophylaxis with pyrimethamine for toxoplasmic encephalitis in patients with advanced human immunodeficiency virus disease : results of a randomized trial . Terry Beirn Community Programs for Clinical Research on AIDS . Pyrimethamine , 25 mg thrice weekly , was evaluated as primary prophylaxis for toxoplasmic encephalitis ( TE ) in a double-blind , randomized clinical trial in patients with human immunodeficiency virus ( HIV ) disease , absolute CD4 lymphocyte count of < 200/microL ( or prior AIDS-defining opportunistic infection ) , and the presence of serum IgG to Toxoplasma gondii . Leucovorin was coadministered only for hematologic toxicity . There was a significantly higher death rate among patients receiving pyrimethamine ( relative risk [ RR ] , 2.5 ; 95 % confidence interval [ CI ] , 1.3-4.8 ; P = .006 ) , even after adjusting for factors predictive of survival . The TE event rate was low in both treatment groups ( not significant ) . Only 1 of 218 patients taking trimethoprim-sulfamethoxazole but 7 of 117 taking aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia developed TE ( adjusted RR for the trimethoprim-sulfamethoxazole group , 0.16 ; 95 % CI , 0.01-1.79 ; P = .14 ) . Thus , for HIV-infected patients receiving trimethoprim-sulfamethoxazole , additional prophylaxis for TE appears unnecessary .
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Intervention_Pharmacological
pyrimethamine
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Intervention_Pharmacological
Pyrimethamine
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Intervention_Pharmacological
Leucovorin
84060
Intervention_Pharmacological
pyrimethamine
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
aerosolized pentamidine
84063
Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
84065
Outcome_Mortality
death rate
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Outcome_Physical
TE event rate
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Participant_Condition
patients with advanced human immunodeficiency virus disease :