Prophylactic treatments against pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients

Trimethoprim-sulfamethozazole prophylaxis may be more effective than dapsone/pyrimethamine or aerosolised pentamidine in the prophylaxis of Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients.

A systematic review including 22 RCTs with a total of 4 870 subjects was abstracted in DARE. For dapsone/pyrimethamine vs. aerosolised pentamidine the risk ratio for P. carinii pneumonia was 0.90 (95% CI 0.71 to 1.15) and for toxoplasma encephalitis it was 0.72 (95% CI 0.54 to 0.97). For trimethoprim-sulfamethoxazole vs. aerosolised pentamidine the risk ratio for P. carinii pneumonia was 0.59 (95% CI 0.45 to 0.76), and for toxoplasma encephalitis it was 0.78 (95% CI 0.55 to 1.11). For mortality it was 0.88 (95% CI 0.74 to 1.06). For trimethoprim-sulfamethoxazole vs. dapsone/pyrimethamine the risk ratio for P. carinii pneumonia was 0.49 (95% CI 0.26 to 0.92), and for toxoplasma encephalitis it was 1.17 (95% CI 0.68 to 2.04), and for mortality it was 0.98 (95% CI 0.80 to 1.08).

Comment: The quality of evidence is downgraded by study quality (few data of the original studies) and by imprecise results (limited study size for each comparison).

Ədəbiyyat

1. Bucher HC, Griffith L, Guyatt GH, Opravil M. Meta-analysis of prophylactic treatments against Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol 1997 Jun 1;15(2):104-14.