ATOVAQUONE FOR SALVAGE TREATMENT AND SUPPRESSION OF TOXOPLASMIC ENCEPHALITIS IN PATIENTS WITH AIDS

To examine the efficacy of atovaquone as salvage therapy in patients w ith AIDS-related toxoplasmic encephalitis, 93 patients with AIDS and t oxoplasmic encephalitis who were intolerant of standard therapy (pyrim ethamine plus sulfadiazine or clindamycin) or for whom such therapy wa s failing were treated with atovaquone tablets (750 mg four times dail y) for 18 weeks, Plasma levels of atovaquone were measured with high-p ressure liquid chromatography, and the clinical and radiological respo nses and survival were compared according to median plasma concentrati on groups. During the acute-therapy phase (the first 6 weeks), the con ditions of 52% and 37% of the patients, respectively, were clinically or radiologically improved; the conditions of 26% and 15% remained cli nically or radiologically improved by week 18. Median survival for all patients was 189 days (Kaplan-Meier estimate). A post-hoc analysis re vealed a positive relationship between clinical and radiological respo nses and median atovaquone plasma concentrations. Survival time among patients with high or medium median steady-state plasma concentrations (319 and 289 days) was significantly better than that among those wit h low plasma concentrations (114 days; P=.003 and P=.006, respectively ).