Primary prophylaxis for pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mm3: a cost-effectiveness analysis

Article Abstract:

Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in patients who are infected with human immunodeficiency virus (HIV), the agent that causes AIDS. PCP is associated with high morbidity (illness) and mortality, but it does not often occur before an HIV-infected individual's immune system is depressed to a certain level, usually when the CD4 lymphocyte counts drop below 200/mm3. There are treatments available that can prevent the development of PCP, and it has been recommended that all HIV-infected individuals begin such treatment when their CD4 counts drop below 200/mm3. The number of people requiring this treatment in the near future could be well over one million. The possible costs to the health care system could be enormous. A treatment that combines safety, effectiveness, and cost efficiency is required. This study examined these factors for three possible PCP-preventive treatments: aerosolized pentamidine, trimethoprim-sulfamethoxazole, and dapsone. A study model was made for comparing life expectancy, costs, side effects, and other factors of each treatment and of no treatment for patients who reached the threshold of immune suppression. Data were gathered from two previous studies. Results showed that life expectancy would increase 18 percent, from 3.2 years to about 3.77 years, in those who were treated with any of the three methods. Treatment costs per person per year were estimated to be $440 for dapsone, $700 for trimethoprim, and $1,680 for pentamidine. When increases in life expectancy were compared with costs, dapsone was the most cost effective. This was so even when other factors such as toxicity, compliance, and the lower number of pentamidine side effects were considered. These results indicate that initial therapy with dapsone or trimethoprim is warranted to prevent PCP in patients with CD4 counts below the established limit, unless side effects require a shift to pentamidine. Treatment would be effective, while approximately $100 million per year would be saved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Dapsone

---

Recommendations for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus

Article Abstract:

Trimethoprim-sulfamethoxazole (TMP-SMX) appears to be more effective than aerosol pentamidine in preventing or delaying recurrent episodes of Pneumocystis carinii pneumonia (PCP) in HIV patients. The high human and financial costs associated with PCP, which used to infect almost all HIV patients, call for early intervention. Treatment should be started in patients whose CD4 cell count drops below 200 cells per cubic millimeter or who have HIV-related thrush and unexplained fevers or who have recovered from a PCP episode. CD4 cell counts should be checked every three to six months to see if treatment is necessary. The optimal form of treatment should be decided on an individual basis. TMP-SMX is less expensive and seemingly more effective but can be toxic, and aerosol pentamidine should not be used in patients with hypoglycemia or pancreatitis. Furthermore, aerosol pentamidine is not likely to prevent the onset of any other HIV-related infections.

Reports, United States. Public Health Service

---

Prophylaxis for disseminated Mycobacterium avium complex (MAC) infection in patients with AIDS: a cost-effectiveness analysis

Article Abstract:

Azithromycin is the most cost-effective drug for the prevention of Mycobacterium avium complex (MAC) infection in AIDS patients. Researchers compared the costs of azithromycin, rifabutin, and clarithromycin therapy, which cost between $994 and $2,185 per patient for prophylactic use.

United States, Care and treatment, Statistical Data Included, AIDS patients, Mycobacterium avium complex, Azithromycin, Opportunistic infections, Clarithromycin, Rifabutin

Similar abstracts:

• Abstracts: The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type I. Survival from early, intermediate, and late stages of HIV infection
• Abstracts: Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia: the San Francisco Community Prophylaxis Trial
• Abstracts: Aerosol pentamidine for secondary prophylaxis of AIDS-related Pneumocystis carinii pneumonia: a randomized, placebo-controlled study
• Abstracts: Thin-walled cavities, cysts, and pneumothorax in Pneumocystis carinii pneumonia: further observations with histopathologic correlation
• Abstracts: Treatment for cerebral toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with AIDS. A controlled study of inhaled pentamidine for primary prevention of Pneumocystis carinii pneumonia

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.