In clinical trials, PS2 patients derive similar benefit from superior treatment as patients with PS of 0 to 1 but with an increased risk of toxicities and 12% 60-day mortality. Although current treatment provides benefit, new approaches are required to approach 1-year median survival for PS2 patients.
Abstract. The epidemiology of human microsporidiosis is poorly understood and environmental factors affecting transmission of the organism have not been fully elucidated. Temporal variation in the prevalence of microsporidia in the stool of patients with human immunodeficiency virus (HIV) infection and diarrhea was studied to evaluate the role of water-borne transmission. From January 1993 to December 1996, 8,439 stools from HIV-infected individuals were examined for microsporidia spores in southern California. Yearly positivity rates were 8.8% in 1993, 9.7% in 1994, 6.6% in 1995, and 2.9% in 1996. An analysis for linear trend showed a statistically significant decrease in stool positivity rates over time ( 2 ϭ 81.9, P ϭ 0.001). No significant seasonal variation in the prevalence of microsporidiosis was seen over that time period. These results suggest the constant presence of microsporidia in the environment, rather than a seasonal association with recreational water use or seasonal contamination of the water supply, and a real decrease in yearly prevalence of microsporidia related diarrhea. Factors related to a progressive decrease in prevalence are subjects of future investigation.Intestinal microsporidiosis is an important cause of diarrhea and wasting in persons with the acquired immune deficiency syndrome (AIDS). The epidemiology of human microsporidiosis is poorly understood and the environmental factors affecting transmission of the organism have yet to be fully elucidated. Water-borne transmission of a pathogen is suggested by temporal variation in the prevalence of the disease. In North America, seasonal variation in the prevalence of Cryptosporidium parvum has been linked to recreational water use, contamination of water supplies, and the rainy season. 1-3 Microsporidiosis has not been studied as extensively. However, seasonal prevalence of both C. parvum and microsporidiosis was examined in Brazil, a developing country with a rainy season. 4 In that study, an excess of C. parvum infection was noted during the rainy season, but no corresponding seasonal variation was noted in the prevalence of human microsporidiosis. 4 These findings by Wuhib and others, 4 who evaluated 295 stool specimens collected from 166 human immunodeficiency virus (HIV)-infected persons over an 18-month period, suggested that contaminated water was not likely to be a major source of microsporidial infection. The goal of the present study was to examine the seasonal variation and prevalence of microsporidia in the stools of HIV-infected persons with chronic diarrhea in southern California over a four-year period. MATERIALS AND METHODSStool specimens were collected as part of routine diagnostic care from HIV-infected persons and examined at the Microbiology Reference Laboratory in Cypress, California from January 1993 through December 1996. The samples came from more than 30 different clinical sites, including the Southern California Permanente Medical Group Central Laboratory, Smith-Kline Beecham Clinical Laboratories, and hosp...
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