PYRIMETHAMINE ALONE AS PROPHYLAXIS FOR CEREBRAL TOXOPLASMOSIS IN PATIENTS WITH ADVANCED HIV-INFECTION

Prophylaxis for toxoplasma encephalitis was performed with pyrimethami ne alone (50 mg daily) in 56 patients with advanced HIV infection, Thi rty-eight patients were at high risk for toxoplasma encephalitis (CD4( +) counts less than or equal to 200/mu l, and presence of serum IgG an tibodies to Toxoplasma gondii), The overall treatment period was 697 m onths (mean 12.5 +/- 12.1), During prophylaxis, only one patient devel oped toxoplasma encephalitis, four patients discontinued treatment due to adverse reactions, steady state pyrimethamine plasma concentration s were measured by gas chromatography. Mean plasma level was 1,887 +/- 1,161 ng/ml, during liver enzyme-inducing comedication plasma levels were significantly (p = 0.0001) reduced (1,488 +/- 884 ng/ml versus 1, 978 +/- 1,196 ng/ml without comedication), All patients received a fol inic acid supplement of 7.5 mg daily, Serum folate levels ranged from 5.7-105 (43.7 +/- 29.2) nmol/l; severe hematological side effects did not occur.