TREATMENT OF NON-MENINGEAL CRYPTOCOCCOSIS IN PATIENTS WITH AIDS

Amphotericin B, alone or combined with flucytosine, is the reference c urative treatment for neuromeningeal cryptococcosis associated with th e acquired immune deficiency syndrome (AIDS). Treatment of non-meninge al forms is less well standardized. Out of 75 human immunodeficiency v irus (HIV)-infected patients with cryptococcosis, 16 had no meningeal involvement. One died before receiving any treatment, another received amphotericine B and recovered, and the remaining 14 received curative therapy with fluconazole (200-400 mg/day); 11 of the latter entered c omplete remission while three deteriorated during the first week of tr eatment but recovered on amphotericin B combined, in two cases, with f luconazole. Only one relapse occurred during maintenance treatment wit h low-dose fluconazole (100 mg/day). No adverse effects of fluconazole treatment were observed. One of the patients on amphotericin B develo ped acute renal impairment requiring drug withdrawal. These results su ggest that first-line fluconazole therapy is effective and well tolera ted in patients with AIDS-associated non meningeal cryptococcosis.