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University of Cincinnati Academic Health Center
Publish Date: 02/21/01
Media Contact: AHC Public Relations, (513) 558-4553
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Preventing Cryptosporidiosis in Advanced HIV-Infected Patients

Cincinnati--Carl J. Fichtenbaum, MD, associate professor of infectious diseases, University of Cincinnati (UC) College of Medicine, said recent research done by himself and his colleagues shows "the drug rifabutin, commonly used to prevent bacterial infection, also prevents infection from the one-cell parasite called Cryptosporidium (or Crypto) in advanced HIV patients." Cryptosporidiosis infection is caused by ingesting water or food that harbors Crypto.

Swallowing contaminated water from rivers, lakes, swimming pools, and hot tubs, places one at greater risk for Crypto infection, but even consuming unfiltered drinking water can be risky, because chlorine treatment doesn't always kill Crypto. In a healthy adult, Crypto-infected water causes acute diarrhea for one to four weeks. In people with AIDS, the illness often becomes chronic, severe, and sometimes fatal. Fichtenbaum's research findings into prevention of Crypto was reported in the December 22, 2000 issue of AIDS and the January 12 Reuters Health Information. "Rifabutin but not clarithromycin (an antibiotic) is effective in preventing cryptosporidiosis in patients with advanced HIV infection who are not receiving potent combination antiviral therapy," Fichtenbaum said.

Fichtenbaum and his colleagues performed a cross-protocol analysis of 2,288 patients with advanced HIV infection. The subjects were enrolled in two prospective clinical trials between December 1992 and June 1995 to prevent specific bacterial and viral infections. While those receiving rifabutin "had about a 50 percent reduction in risk of developing Crypto, clarithromycin showed no effect," Fichtenbaum said.

People with immune systems compromised by anti-rejection drugs (used in transplants), chemotherapy, or HIV infection are at increased risk of severe cryptosporidiosis. The best way to prevent exposure to Crypto is to drink only boiled, filtered, or bottled water, and to make sure raw fruits and vegetables have been peeled, properly washed, and/or disinfected.

Fichtenbaum said, "Rifabutin is an inexpensive and effective medication for use in developing countries where there is no access to potent antiviral drugs." He cautioned that rifabutin should not be given by itself when a patient has tuberculosis (TB) as it may lead to an antibiotic-resistant form of TB.

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