ALBENDAZOLE CHEMOTHERAPY FOR TREATMENT OF DIARRHEA IN PATIENTS WITH AIDS IN ZAMBIA - A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL

Objective-To determine the value of short course, high dose albendazol e chemotherapy in the treatment of persistent diarrhoea related to HIV in unselected patients in urban Zambia. Design-A randomised double bl ind placebo controlled trial of albendazole 800 mg twice daily for two weeks. Patients were monitored intensively for one month and followed for up to six months. Setting-Home care AIDS services in Lusaka and N dola. Patients-174 HIV seropositive patients with persistent diarrhoea (defined as loose but not bloody stools three or more times a day for three weeks or longer). No investigations were undertaken except HIV testing after counselling. Main outcome measures-Proportion of time pe riods during which diarrhoea was experienced after completion of treat ment; proportion of patients with full remission after completion of t reatment; mortality. Results-The patients taking albendazole had diarr hoea on 29% fewer days than those taking placebo (P<0.0001) in the two weeks after treatment. The benefit of albendazole was maintained over six months. In patients with a Karnofsky score of 50 to 70 (needing h elp with activities of daily living and unable to work, but not needin g admission to hospital) diarrhoea was reduced by 50%. Remission was o btained in 26% of all patients who received albendazole (P=0.004 again st 9% receiving placebo), and this difference was maintained over six months (log rank test, P=0.003). Albendazole had no effect on mortalit y. Minimal adverse effects were noted. Conclusions-For HIV infected Za mbians with diarrhoea of more than three weeks' duration albendazole o ffers substantial relief from symptoms and may be used empirically, wi thout prior investigation.