publicdata/ahrq-gov
1
0
Fork 0
Code Issues Pull requests Projects Releases Packages Wiki Activity Actions
ahrq-gov/archive.ahrq.gov/research/apr96/dept7.htm
Scott Williams 58222b51ed Initial commit
2025-02-28 14:14:25 -05:00

204 lines
No EOL
12 KiB
HTML
Raw Blame History

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<title>Research Activities, April 1996: HIV/AIDS Research</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<!-- "metadata" -->
<meta name="Title" content="Research Activities, April 1996" />
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, AIDS/HIV, ambulatory care, benchmark, child, cost, elderly, health cost, healthcare cost, hospital, long-term care, managed care, markets, mental health, methodology, minority health, nursing, nursing homes, outcome research, out-of-pocket spending, patient care, primary, primary care, research, rural, spending, study, Translating Research Into Practice, TRIP" />
<meta name="description" content="Online newsletter summarizing published findings from AHRQ-funded studies, new AHRQ publications and products, and funding opportunities." />
<meta name="creator" content="Agency for Healthcare Research and Quality (AHRQ)" />
<meta name="datecreated" content="April 1996" />
<meta name="datereviewed" content="April 1996" />
<meta name="language" content="English" />
<!-- end metadata -->
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
<script>
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
ga('create', 'UA-75759936-1', 'auto');
ga(' set', 'anonymizeIp', true);
ga('send', 'pageview');
</script></head><body><!-- Google Tag Manager -->
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
<!-- End Google Tag Manager -->
<noscript>
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
</noscript>
<!-- Page Header v2.0 -->
<a name="top" id="top"></a>
<!--Begin Banner CodeS-->
<div id="ahrqbanner">
<div class="hhsportion">
<a href="#h1" class="skipnav">Skip Navigation</a>
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
</a>
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
</a>
</div>
<div class="ahrqportion">
<a href="/" title="Archive: Agency for Healthcare Research Quality">
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
<input type="hidden" name="entqr" value="0" />
<input type="hidden" name="output" value="xml_no_dtd" />
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
</form>
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home&#8212;Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | &nbsp;<img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
</div>
<div id="PrintBanner">
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
</div>
<a name="h1"></a>
<!-- End banner code -->
<!-- End of Page header -->
<!-- Content Body -->
<div id="mainContent">
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
<tr valign="top">
<td width="70%">
<!-- Center Content section -->
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
<!--DWLayoutTable-->
<tr>
<td class="crumb_link"><div id="crumbContent">
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> &gt; <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> &gt; <a href="." class="crumb_link">April 1996</a> </span></p>
</div>
</td>
</tr>
<tr>
<td><h1><a name="h1" id="h1"></a>HIV/AIDS Research </h1>
</td>
</tr>
<tr>
<td><div id="centerContent"><div class="headnote">
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<a name="head1"></a>
<h2>Trimethoprim-sulfamethoxazole continues to be the best
choice for preventing PCP in AIDS patients</h2>
<p><em>Pneumocystis carinii</em> pneumonia (PCP) remains one of the most
common life-threatening complications of AIDS. Of the three
regimens most often used for PCP prophylaxis,
trimethoprim-sulfamethoxazole (TMP-SMX) is superior to prevent
initial and second-time PCP (primary and secondary prophylaxis)
and most cost-effective for secondary prophylaxis, according to
two studies supported in part by the Agency for Health Care
Policy and Research (HS07782 and HS06694).</p><p>
A meta-analysis of 35 randomized trials (conducted between 1991
and 1995 and involving 6,583 patients) led by Joseph Lau, M.D.,
of New England Medical Center Hospitals, compared three different
treatment regimens: TMP-SMX, dapsone, (both are oral
medications), and aerosolized pentamidine (AP) with each other or
placebo. AP was well tolerated regardless of the dose used (usual
recommended dose is 300 mg per month via nebulizer), but
prophylaxis failure might be halved if the dose were doubled.
Oral medications were five times more likely than AP to be
discontinued because of toxic reactions.</p>
<p>Regardless of dose, TMP-SMX was almost universally effective for
patients who tolerated it. The risk of discontinuation because of
side effects decreased 43 percent if one double-strength tablet
(160 mg TMP, 800 mg SMX) was given three times per week instead
of daily (usual recommended dose). For dapsone, in 100 patients
given 100 mg per day instead of twice per week for 1 year
(primary prophylaxis), 7 fewer patients would develop PCP, but 17
more would have significant toxic reactions.</p><p>
The second study shows that TMP-SMX also is more cost-effective
than AP for preventing recurring PCP. Investigators at Dartmouth
Medical School developed a model of secondary PCP prophylaxis
based on the medical literature and then used efficacy and
toxicity data from a controlled clinical trial to validate the
model. They compared three clinical strategies in a hypothetical
group of patients who had completed 21 days of therapy for PCP:
no prophylaxis (control group), prophylaxis with TMP-SMX (one
double-strength tablet per day), and prophylaxis with AP (300 mg
per month).</p>
<p>In the literature-based model, yearly prophylaxis costs for
TMP-SMX and AP were $468 and $1,577, respectively. Assuming equal
efficacy for the two agents, the incremental cost-effectiveness
ratio for TMP-SMX was $350 compared with no prophylaxis; for AP
it was $110,880 compared with TMP-SMX, since AP was associated
with only a minimal increase in life expectancy and a substantial
increase in cost. Data from the randomized trial indicated annual
costs of $656 per person for TMP-SMX and $1,573 per person for
AP. This translates into annual savings of over $17.4 million for
the 19,039 patients newly diagnosed as having PCP in 1993, if
they were started on TMP-SMX rather than AP to prevent
reinfection with PCP.</p>
<p>More details of the first study are in "Meta-analysis of the
relative efficacy and toxicity of <em>Pneumocystis carinii</em> prophylactic regimens," by John P. Ioannidis, M.D., Joseph C.
Cappeleri, Ph.D., M.P.H., Paul R. Skolnik, M.D., and others, in
the January 22, 1996 <em>Archives of Internal Medicine</em> 156,
pp. 177-188.</p> <p>For the second study, see "Validating
literature-based models with direct clinical trial results," by
Kenneth A Freedberg, M.D., M.Sc., W. David Hardy, M.D., Robert S.
Holzman, M.D., and others, in the January 1996 issue of <em>Medical Decision Making</em> 16(1), pp. 29-35. </p>
<p class="size2"><a href=".">Return to Contents</a><br />
<a href="dept8.htm">Proceed to Next Article</a></p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
<p>&nbsp;</p>
</div>
</td>
</tr>
</table>
<!-- End of Center Content section -->
</td>
</tr>
</table>
</div>
<!-- End of Content Body -->
<!-- Footer graphic 1.2-->
<table cellspacing="0" cellpadding="0" border="0" width="100%">
<tr>
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
</tr>
</table>
<!-- Footer links section -->
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health &amp; Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
</div>
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
<!-- End of Footer links section -->
</body>
</html>
Reference in a new issue View git blame Copy permalink