Treatment for Cerebral Toxoplasmosis Protects against Pneumocystis carinii Pneumonia in Patients with AIDS

  1. Alison Heald, MD;
  2. Markus Flepp, MD;
  3. Jean-Philippe Chave, MD;
  4. Raffaele Malinverni, MD;
  5. Sigmund Rüttimann, MD;
  6. Victor Gabriel;
  7. Catherine Renold, MD;
  8. Aviva Sugar, MD; and
  9. Bernard Hirschel, MD
  1. the Swiss HIV Cohort Study*

    Abstract

    ▪ Objective: To determine whether long-term maintenance treatment for toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS).

    ▪ Design: Cohort study.

    ▪ Setting: Switzerland.

    ▪ Patients: A total of 453 patients with human immunodeficiency virus (HIV) entered the Swiss HIV Cohort Study. Ninety-nine patients with cerebral toxoplasmosis but no previous or simultaneous P. carinii pneumonia were compared with 240 patients with AIDS and other severe opportunistic infections (Centers for Disease Control [CDC] stage IVC1 infection other than toxoplasmosis and P. carinii pneumonia) as well as with 114 patients receiving inhaled pentamidine in a study of primary pneumocystis prophylaxis in patients infected with HIV.

    ▪ Measurements: Life-table analysis for P. carinii-free survival.

    ▪ Main Results: Six of 99 (6%) patients with toxoplasmosis, 50 of 240 (21%) patients with other severe opportunistic infections, and 8 of 114 (6%) patients receiving inhaled pentamidine developed P. carinii pneumonia. Life-table analysis showed that the incidence of pneumonia was substantially lower in patients with toxoplasmosis compared with that in patients with other severe opportunistic infections and was similar to the incidence in patients receiving pentamidine as prophylaxis. Analysis of the medication records from patients with toxoplasmosis showed that pyrimethamine and sulfonamides were administered 50% of the time; pyrimethamine and clindamycin, 25% of the time; and pyrimethamine alone, 9.9% of the time but that only one of the six patients with toxoplasmosis who developed P. carinii pneumonia received pyrimethamine and sulfonamides in the month before diagnosis.

    ▪ Conclusion: Patients with cerebral toxoplasmosis have a low risk for subsequently developing P. carinii pneumonia. This decreased risk is probably the result of chronic suppressive treatment with pyrimethamine and sulfonamides.

    Article and Author Information

    • From the Hôpital Cantonal Universitaire de Genève, Geneva; University Hospital, Zürich; Centre Hopitalier Universitaire Vaudois, Lausanne; Medizinische Poliklinik, Bern; and Medizinische Poliklinik, Basel, Switzerland. For current author addresses, see end of text.

    • ↵* For a list of the members of the Swiss HIV Cohort Study, see the Appendix.

    • Grant Support: By a grant from the Swiss Federal Office for Public Health.

    • Requests for Reprints: Bernard Hirschel, MD, Division des Maladies infectieuses, Hôpital Cantonal Universitaire de Genève, 24 rue Michelidu-Crest, CH-1211 Geneva 4, Switzerland.

    • Current Author Addresses: Drs. Heald, Renold, and Hirschel and Mr. Gabriel: Division des Maladies infectieuses, Hôpital Cantonal Universitaire de Genève, 24 rue Micheli-du-Crest, CH-1211 Geneva 4, Switzerland.

      Dr. Flepp: Division of Infectious Diseases, Universitatsspital, Ramistrasse 100, CH-8091 Zürich, Switzerland.

      Drs. Chave and Sugar: Division of Infectious Diseases, Centre Hôpitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland.

      Dr. Malinverni: Medizinische Poliklinik, Inselspital Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.

      Dr. Rüttimann: Medizinische Poliklinik, Kantonsspital, CH-4031 Basel, Switzerland.

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    1. Ann Intern Med November 15, 1991 vol. 115 no. 10 760-763
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