INITIAL THERAPY FOR ACQUIRED IMMUNODEFICIENCY SYNDROME-ASSOCIATED CRYPTOCOCCOSIS WITH FLUCONAZOLE

Background: Published opinion has generally favored amphotericin B ove r fluconazole as initial therapy for acquired immunodeficiency syndrom e-associated cryptococcosis, although data that support this recommend ation are limited. Method: Retrospective review of 30 consecutive pati ents with acquired immunodeficiency syndrome-associated cryptococcosis seen at a single institution over a 1-year period and given fluconazo le, 400 mg/d, as initial therapy. Results: 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; cereb rospinal fluid cryptococcal antigen titer was greater than 1:1024 in 1 2 of 23 patients; and five of 30 patients presented with altered menta l status. The median CD4 count at diagnosis was 0.042 X 10(9)/L (42/mu L). Eight of 25 patients who were followed up for more than 30 days r elapsed, as evidenced by a positive culture, all relapses were success fully treated with fluconazole, either by reinstitution of therapy or by increase of dosage. Conclusion: This experience supports the use of fluconazole as initial therapy for acquired immunodeficiency syndrome -associated cryptococcosis.