Ketoconazole Therapy for AIDS Patients With Disseminated Histoplasmosis-Reply

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Abstract
In Reply. —Ketoconazole failed to prevent clinical relapse with disseminated histoplasmosis in the patient with AIDS described by Drs Gustafson and Henson. Their patient also failed amphotericin B therapy, presumably because of the severe immune incompetence associated with AIDS. Based on the encouraging experience of Dr Bonner and co-workers, I have used ketoconazole to prevent relapse in two patients with AIDS and histoplasmosis.1 Both patients subsequently suffered a relapse. The first patient, a 29-year-old male drug addict, developed recurrent disseminated histoplasmosis manifested as fever and chronic meningitis while receiving 400 mg/day of ketoconazole. Histoplasma capsulatum was isolated from the cerebrospinal fluid, but blood and bone marrow cultures were negative. His meningitis initially responded to amphotericin B therapy, but he eventually died with persistent central nervous system histoplasmosis. Neither ketoconazole nor amphotericin B cross the blood-brain barrier well, perhaps explaining the patient's relapse with chronic meningitis. The second patient, a

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