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AEROSOLIZED PENTAMIDINE PROLONGS SURVIVAL BETTER THAN TMP/SMX

Executive Summary

AEROSOLIZED PENTAMIDINE PROLONGS SURVIVAL BETTER THAN TMP/SMX in cases of advanced HIV disease, according to the results of a two-year, multicenter study of 1,048 AIDS patients. The study employed Fujisawa/Lyphomed's aerosolized pentamidine product Nebupent and the generically-available trimethoprim/sulfamethoxazole (marketed by Roche as Bactrim and by Burroughs Wellcome as Septra). Richard Chaisson, Johns Hopkins University School of Medicine, reported results of the study at the seventh International AIDS Conference in Florence, Italy, June 16-21. While both aerosolized pentamidine and TMP/SMX were associated with a decreased risk of development of Pneumocystis carinii pneumonia, only PCP prophylaxis with Nebupent was related to improved survival. Seventeen percent of patients who received TMP/SMX developed PCP, while 22% of patients given aerosolized pentamidine developed PCP. TMP/SMX is the drug of choice for many physicians because it has been considered to be equally efficacious and is a fraction of the cost of pentamidine. Chaisson's study is one of the first to compare the two drugs' effect on survival. Patients who remained on AZT more than 80% of the time also had prolonged survival, Chaisson said: "Aerosolized pentamidine therapy and zidovudine [AZT] therapy were each independently associated with improved survival." Of the 1,048 patients in the study, 60% received aerosolized pentamidine and 19% received TMP/SMX. Chaisson said many patients had low blood cell counts and may not have been able to tolerate TMP/SMX. But he noted that the adverse effects of TMP/SMX "may limit its long-term use."
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