Volume 10, Number 10—October 2004
Research
Sulfa Use, Dihydropteroate Synthase Mutations, and Pneumocystis jirovecii Pneumonia
Table 1
Study | Location/data collection calendar midpointa | N | Multiple isolates per patient | Defined prophylaxis timingb | Defined treatment outcomec,d | Proportion HIV+ | RD (95% CI) (95% CLD)d | |
---|---|---|---|---|---|---|---|---|
Prophylaxis effect on mutation | ||||||||
Kazanjian (1998) (21) | USA/1994 | 27 | No | Yes | NA | 0.74 | 0.61 (0.25, 0.97) (0.72) | |
Helweg-Larsen (22) | Denmark/1994 | 152 | Yes | Yes | NA | 1.00 | 0.51 (0.33, 0.70) (0.37) | |
Ma (1999) (23) | USA/1992 | 37 | Yes | Yes | NA | 0.70 | 0.69 (0.43, 0.94) (0.51) | |
Huang (24) | USA/1998 | 111 | No | Yes | NA | 1.00 | 0.33 (0.15, 0.51) (0.36) | |
Kazanjian (2000) (25) | USA/1995 | 97 | No | Yes | NA | 1.00 | 0.52 (0.35, 0.70) (0.35) | |
Visconti (26) | Italy/1995 | 20 | Yes | No | NA | 1.00 | 0.60 (0.20, 1.00) (0.80) | |
Ma (2002) (27) | Italy/1998 | 107 | No | Yes | NA | 1.00 | 0.15 (0.01, 0.30) (0.29) | |
Costa (28) | Portugal/1998 | 89 | No | Yes | NA | 0.93 | 0.10 (–0.15, 0.35) (0.50) | |
Crothers (29) | USA/2000 | 236 | Yes | Yes | NA | 1.00 | 0.16 (0.06. 0.25) (0.19) | |
Latouche (30) | France/2000 | 92 | No | Yes | NA | 0.90 | –0.03 (–0.22, 0.16) (0.38) | |
Miller (31) | England/1993 | 25 | No | Yes | NA | 1.00 | 0.31 (–0.08, 0.69) (0.77) | |
Nahimana (32) | France/1995 | 158 | No | Yes | NA | 0.76 | 0.50 (0.31, 0.69) (0.38) | |
Zingale (33) |
Italy/1999 |
64 |
Yes |
Yes |
NA |
1.00 |
0.61 (0.42, 0.80) (0.38) |
|
Mutation effect on treatment outcome | ||||||||
Kazanjian (2000) (25) | USA/1995 | 97 | No | NA | Yes | 1.00 | 0.22 (0.01, 0.43) (0.42) | |
Takahashi (34) | Japan/1997 | 24 | No | NA | Yes | 0.67 | 0.89 (0.59, 1.19) (0.60) | |
Ma (2002) (27) | Italy/1998 | 107 | No | NA | NA | 1.00 | –0.01 (–0.22, 0.20) (0.42) | |
Navin (35) | USA/1997 | 136 | No | NA | Yes | 1.00 | –0.21 (0.39, –0.03) (0.36) | |
Visconti (26) |
Italy/1995 |
20 |
Yes |
NA |
No |
1.00 |
–0.21 (–0.82, 0.40)
(1.22) |
|
aData collection calendar midpoint, the midpoint in calendar time of data collection. bDefined prophylaxis timing, whether the study stated the timing of prophylaxis in relation to the episode of Pneumocystis jirovecii pneumonia. cDefined treatment outcome, whether the study stated how it defined treatment outcome. dRD, risk difference; CI, confidence interval; CLD, confidence limit difference; NA, not applicable. |
References
- Fisk DT, Meshnick S, Kazanjian PH. Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome. Clin Infect Dis. 2003;36:70–8. DOIPubMedGoogle Scholar
- Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study investigators. N Engl J Med. 1998;338:853–60. DOIPubMedGoogle Scholar
- Kaplan JE, Hanson D, Dworkin MS, Frederick T, Bertolli J, Lindegren ML, Epidemiology of human immunodeficiency virus–associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;30(Suppl 1):S5–14. DOIPubMedGoogle Scholar
- Cohn DL, Breese PS, Burman WJ, Lopez DL, Barth BL, Rietmeijer CA, Continued benefit from highly active antiretroviral therapy: trends in AIDS-related opportunistic illnesses in a public health care system, 1990–2001. XIV International AIDS Conference. Barcelona, Spain, 2002. Abstract no. ThOrC1443. Available from www.aids2002.com/home.asp
- Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360:119–29. DOIPubMedGoogle Scholar
- Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA. 1999;282:2220–6. DOIPubMedGoogle Scholar
- Bennett KK, DeGruttola VG, Marschner IC, Havlir DV, Richman DD. Baseline predictors of CD4 T-lymphocyte recovery with combination antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:20–6.PubMedGoogle Scholar
- Hicks C, King MS, Gulick RM, White AC Jr, Eron JJ Jr, Kessler HA, Long-term safety and durable antiretroviral activity of lopinavir/ritonavir in treatment-naive patients: 4 year follow-up study. AIDS. 2004;18:775–9. DOIPubMedGoogle Scholar
- Garcia F, De Lazzari E, Plana M, Castro P, Mestre G, Mondedeu M, Long-term CD4+ T-cell response to highly active antiretroviral therapy according to baseline CD4+ T-cell count. J Acquir Immune Defic Syndr. 2004;36:702–13. DOIPubMedGoogle Scholar
- The WHO and UNAIDS global initiative to provide antiretroviral therapy to 3 million people with HIV/AIDS in developing countries by the end of 2005. Geneva: World Health Organization; 2003.
- Walzer PD, Foy J, Steele P, Kim CK, White M, Klein RS, Activities of antifolate, antiviral, and other drugs in an immunosuppressed rat model of Pneumocystis carinii pneumonia. Antimicrob Agents Chemother. 1992;36:1935–42.PubMedGoogle Scholar
- Kunz S, Junker U, Blaser J, Joos B, Meyer B, Zak O, The SCID mouse as an experimental model for the evaluation of anti-Pneumocystis carinii therapy. J Antimicrob Chemother. 1995;36:137–55. DOIPubMedGoogle Scholar
- Bonora S, Di Perri G, Vento S, Cazzadori A, Concia E. Failure of prophylaxis against PCP in patients with HIV infection. AIDS Patient Care STDS. 1998;12:843–8. DOIPubMedGoogle Scholar
- Moorman AC, Von Bargen JC, Palella FJ, Holmberg SD. Pneumocystis carinii pneumonia incidence and chemoprophylaxis failure in ambulatory HIV-infected patients. HIV Outpatient Study (HOPS) investigators. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;19:182–8.PubMedGoogle Scholar
- Rothman KJ, Greenland S. Modern epidemiology. Philadelphia: Lippincott Williams and Wilkins; 1998.
- Altman DG. Confidence intervals for the number needed to treat. BMJ. 1998;317:1309–12.PubMedGoogle Scholar
- Poole C. Low P-values or narrow confidence intervals: which are more durable? Epidemiology. 2001;12:291–4. DOIPubMedGoogle Scholar
- Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101. DOIPubMedGoogle Scholar
- Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.PubMedGoogle Scholar
- Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med. 1999;18:2693–708. DOIPubMedGoogle Scholar
- Kazanjian P, Locke AB, Hossler PA, Lane BR, Bartlett MS, Smith JW, Pneumocystis carinii mutations associated with sulfa and sulfone prophylaxis failures in AIDS patients. AIDS. 1998;12:873–8. DOIPubMedGoogle Scholar
- Helweg-Larsen J, Benfield TL, Eugen-Olsen J, Lundgren JD, Lundgren B. Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P. carinii pneumonia. Lancet. 1999;354:1347–51. DOIPubMedGoogle Scholar
- Ma L, Borio L, Masur H, Kovacs JA. Pneumocystis carinii dihydropteroate synthase but not dihydrofolate reductase gene mutations correlate with prior trimethoprim-sulfamethoxazole or dapsone use. J Infect Dis. 1999;180:1969–78. DOIPubMedGoogle Scholar
- Huang L, Beard CB, Creasman J, Levy D, Duchin JS, Lee S, Sulfa or sulfone prophylaxis and geographic region predict mutations in the Pneumocystis carinii dihydropteroate synthase gene. J Infect Dis. 2000;182:1192–8. DOIPubMedGoogle Scholar
- Kazanjian P, Armstrong W, Hossler PA, Lane BR, Bartlett MS, Smith JW, Pneumocystis carinii mutations are associated with duration of sulfa or sulfone prophylaxis exposure in AIDS patients. J Infect Dis. 2000;182:551–7. DOIPubMedGoogle Scholar
- Visconti E, Ortona E, Mencarini P, Margutti P, Marinaci S, Zolfo M, Mutations in dihydropteroate synthase gene of Pneumocystis carinii in HIV patients with Pneumocystis carinii pneumonia. Int J Antimicrob Agents. 2001;18:547–51. DOIPubMedGoogle Scholar
- Ma L, Kovacs JA, Cargnel A, Valerio A, Fantoni G, Atzori C. Mutations in the dihydropteroate synthase gene of human-derived Pneumocystis carinii isolates from Italy are infrequent but correlate with prior sulfa prophylaxis. J Infect Dis. 2002;185:1530–2. DOIPubMedGoogle Scholar
- Costa MC, Helweg-Larsen J, Lundgren B, Antunes F, Matos O. Mutations in the dihydropteroate synthase gene of Pneumocystis jiroveii isolates from Portuguese patients with Pneumocystis pneumonia. Int J Antimicrob Agents. 2003;22:516–20. DOIPubMedGoogle Scholar
- Crothers K, Huang L, Morris A, Fox M, Groner G, Turner JR, Pneumocystis dihydropteroate synthase mutations in patients with Pneumocystis pneumonia who are newly diagnosed with HIV infection. J Eukaryot Microbiol. 2003;50:609–10. DOIPubMedGoogle Scholar
- Latouche S, Lacube P, Maury E, Bolognini J, Develoux M, Girard PM, Pneumocystis jirovecii dihydropteroate synthase genotypes in French patients with pneumocystosis: a 1998-2001 prospective study. Med Mycol. 2003;41:533–7. DOIPubMedGoogle Scholar
- Miller RF, Lindley AR, Ambrose HE, Malin AS, Wakefield AE. Genotypes of Pneumocystis jiroveci isolates obtained in Harare, Zimbabwe, and London, United Kingdom. Antimicrob Agents Chemother. 2003;47:3979–81. DOIPubMedGoogle Scholar
- Nahimana A, Rabodonirina M, Zanetti G, Meneau I, Francioli P, Bille J, Association between a specific Pneumocystis jiroveci dihydropteroate synthase mutation and failure of pyrimethamine/sulfadoxine prophylaxis in human immunodeficiency virus-positive and -negative patients. J Infect Dis. 2003;188:1017–23. DOIPubMedGoogle Scholar
- Zingale A, Carrera P, Lazzarin A, Scarpellini P. Detection of Pneumocystis carinii and characterization of mutations associated with sulfa resistance in bronchoalveolar lavage samples from human immunodeficiency virus-infected subjects. J Clin Microbiol. 2003;41:2709–12. DOIPubMedGoogle Scholar
- Takahashi T, Hosoya N, Endo T, Nakamura T, Sakashita H, Kimura K, Relationship between mutations in dihydropteroate synthase of Pneumocystis carinii f. sp. hominis isolates in Japan and resistance to sulfonamide therapy. J Clin Microbiol. 2000;38:3161–4.PubMedGoogle Scholar
- Navin TR, Beard CB, Huang L, del Rio C, Lee S, Pieniazek NJ, Effect of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of P. carinii pneumonia in patients with HIV-1: a prospective study. Lancet. 2001;358:545–9. DOIPubMedGoogle Scholar
- Poole C, Greenland S. Random-effects meta-analyses are not always conservative. Am J Epidemiol. 1999;150:469–75.PubMedGoogle Scholar
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