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Discontinuation of Antifungal Therapy for Cryptococcosis after Immunologic Response to Antiretroviral Therapy J. A. ABERG*, R. W. PRICE, D. M. HEEREN, R. B. PEARCE, and B. BREDT.
Univ of California, San Francisco
Objective: To determine if anti-cryptococcal therapy can be withdrawn
from subjects who have received twelve months of fluconazole therapy,
are asymptomatic for cryptococcosis for at least 16 weeks, have CD4+ count
> 150 cells/µl and are on antiretroviral therapy for 16 weeks; and to
estimate the duration of time these subjects remain free of cryptococcal
infection.
Methods: Six patients with a history of disseminated cryptococcosis
met the above criteria, including one patient who had developed focally
invasive cryptococcal encephalitis within a few months after presenting
with meningitis and while on fluconazole. Cerebrospinal fluid (CSF) and
peripheral blood were obtained for fungal culture and cryptococcal antigen
(CRAG). A urine culture was also obtained. Cytokine flow cytometry (CFC)assays
were performed.
Results: All six patients had negative CSF and blood cultures and
then discontinued antifungal therapy at week 4 . CSF, urine and
blood cultures obtained 4 weeks off therapy (week 8) were also negative.
CSF analysis for cells, protein and glucose at weeks 0 and
8 were normal. CFC results were variable among the six patients. All of
the patients remain asymptomatic off anti-cryptococcal therapy.
Conclusion: These pilot results suggest that disseminated cryptococcal
infection can be "cured" by a period of prolonged antifungal therapy in
some individuals after they have experienced immunologic responses
related to antiretroviral therapy.
Key Words: Cryptococcosis, ImmuneReconstitution, Prophylaxis
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