Continued Prophylactic Treatment Of P. Marneffei Can Prevent Relapse

A large number of patients in Thailand who are infected with the Human Immunodeficiency Virus (HIV) have become ill from a previously very rare fungus called Penicillium Marneffei. Giving prophylactic itraconazole, an anti-fungal drug, to patients who have been treated for P. Marneffei, a potentially fatal fungal infection, can prevent a relapse of the infection. In a study of patients with HIV infection who responded to primary treatment for Penicillium Marneffei, researchers from the Johns Hopkins School of Public Health and Chiang Mai University in Thailand successfully administered itraconazole and prevented the recurrence of P. Marneffei. The study was published in the December 10, 1998 issue of The New England Journal of Medicine.

Kenrad Nelson, MD, professor, Epidemiology, Johns Hopkins School of Public Health said, "The relapse rate for P. Marneffei is about 50 percent in those patients without continued preventive treatment. We wanted to find a preventive treatment that was highly effective and well tolerated. We didn't expect the drug would work as well as it did." Dr. Nelson's team looked at 71 HIV- positive patients in Thailand who had received treatment for P. Marneffei. Half of them received itraconazole and half received a placebo. Twenty of those in the placebo group, more than half, had a relapse of P. Marneffei during the course of the study. None of those treated with itraconazole had a relapse. The median time to relapse was 24 weeks.

In northern Thailand, P. Marneffei is the third most common opportunistic infection in HIV patients. The infection causes weight loss, fever, anemia, and skin lesions. It has a 20% fatality rate even with appropriate treatment but is 100% fatal if not diagnosed and treated. Preventing relapse is highly preferable to treatment since some relapses can not be treated successfully. Dr. Nelson said, "This regimen should be the standard of care for patients with AIDS and P. Marneffei infection which is very common in AIDS patients in Thailand."

The study was supported by grants from Janssen Pharmaceutica, with support from the World Health Organization (WHO).