       Document 0808
 DOCN  M9640808
 TI    Prospects for preventing cryptococcosis in persons infected with human
       immunodeficiency virus.
 DT    9604
 AU    Pinner RW; Hajjeh RA; Powderly WG; National Center for Infectious
       Diseases, Centers for Disease; Control and Prevention, Atlanta, Georgia
       30333, USA.
 SO    Clin Infect Dis. 1995 Aug;21 Suppl 1:S103-7. Unique Identifier :
       AIDSLINE MED/96002836
 AB    Cryptococcosis is a major cause of illness and death among persons
       infected with human immunodeficiency virus (HIV). Its management must
       include both initial and maintenance treatment. Although most
       authorities favor an initial period of therapy with amphotericin B for
       acute cryptococcosis, the triazoles play a role in both the management
       of acute disease and subsequent maintenance therapy. AIDS surveillance
       data collected by the Centers for Disease Control and Prevention
       document the occurrence of cryptococcosis in more than 17,000 (6.2%) of
       adults with AIDS in the United States, although this figure is known to
       be an underestimate. The risk of cryptococcosis among HIV-infected
       persons is highest at CD4+ lymphocyte counts of < 100/microL. Although
       cryptococcosis is especially frequent among AIDS patients who are black,
       male, or injection drug users, the explanations for these patterns
       remain unclear. Whether geographic differences in rates of
       cryptococcosis result from variations in the environmental distribution
       of Cryptococcus neoformans as well as in the distribution of HIV
       infection is also unclear. Although exposure to pigeon feces is the best
       known of the putative exposure-related risk factors, proof is lacking
       that avian excreta are the primary environmental source of the organism
       in most cases of cryptococcosis. Prophylaxis with triazoles can prevent
       cryptococcosis and may be considered for adults and adolescents with
       CD4+ counts of < 50/microL. However, it is uncertain whether prophylaxis
       will affect survival, be cost-effective, or have an adverse impact on
       the susceptibility of a variety of fungi to antifungal drugs. Vaccines
       and monoclonal antibodies designed to prevent or modify cryptococcosis
       in HIV-infected persons are in the experimental stage.
 DE    Adult  Amphotericin B/THERAPEUTIC USE
       Cryptococcosis/EPIDEMIOLOGY/*PREVENTION & CONTROL  Female  Human  HIV
       Infections/*COMPLICATIONS  Incidence  Male  Risk Factors  United
       States/EPIDEMIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

