Initial therapy for acquired immunodeficiency syndrome-associated cryptococcosis with fluconazole

Abstract

<h3>Background:</h3> Published opinion has generally favored amphotericin B over fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis, although data that support this recommendation are limited. <h3>Method:</h3> Retrospective review of 30 consecutive patients with acquired immunodeficiency syndrome— associated cryptococcosis seen at a single institution over a 1-year period and given fluconazole, 400 mg/d, as initial therapy. <h3>Results:</h3> No patient died within the first 30 days of therapy, and none of the 14 patients who died within 1 year had clinically detectable infection when last seen or at death. Pretreatment blood cultures were positive in 26 of 27 patients; cerebrospinal fluid cryptococcal antigen titer was greater than 1:1024 in 12 of 23 patients; and five of 30 patients presented with altered mental status. The median CD4 count at diagnosis was 0.042 ×10⁹/L (42/μL). Eight of 25 patients who were followed up for more than 30 days relapsed, as evidenced by a positive culture; all relapses were successfully treated with fluconazole, either by reinstitution of therapy or by increase of dosage. <h3>Conclusion:</h3> This experience supports the use of fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis. (Arch Intern Med. 1995;155:538-540)