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Albendazole chemotherapy for treatment of diarrhoea in patients with AIDS in Zambia: a randomised double blind controlled trial

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7040.1187 (Published 11 May 1996) Cite this as: BMJ 1996;312:1187
  1. Paul Kelly, research fellowa,
  2. Florence Lungu, managera,
  3. Eileen Keane, consultant physicianb,
  4. Rachel Baggaley, physicianc,
  5. Frida Kazembe, senior registrara,
  6. Joseph Pobee, professor of medicinea,
  7. Michael Farthing, professor of gastroenterologyd
  1. a University Teaching Hospital, Lusaka, Zambia
  2. b Ndola Central Hospital AIDS Home Care Service, Ndola, Zambia
  3. c Kara Counselling and Training Trust, Lusaka
  4. d Digestive Diseases Research Centre, Medical College of St Bartholomew's Hospital, London EC1M 6BQ
  1. Correspondence to: Dr P Kelly, Digestive Diseases Research Centre, Medical College of St Bartholomew's Hospital, London EC1M 6BQ.
  • Accepted 27 February 1996

Abstract

Objective: To determine the value of short course, high dose albendazole chemotherapy in the treatment of persistent diarrhoea related to HIV in unselected patients in urban Zambia.

Design: A randomised double blind placebo controlled trial of albendazole 800 mg twice daily for two weeks. Patients were monitored intensively for one month and followed for up to six months.

Setting: Home care AIDS services in Lusaka and Ndola.

Patients: 174 HIV seropositive patients with persistent diarrhoea (defined as loose but not bloody stools three or more times a day for three weeks or longer). No investigations were undertaken except HIV testing after counselling.

Main outcome measures: Proportion of time periods during which diarrhoea was experienced after completion of treatment; proportion of patients with full remission after completion of treatment; mortality.

Results: The patients taking albendazole had diarrhoea on 29% fewer days than those taking placebo (P<0.0001) in the two weeks after treatment. The benefit of albendazole was maintained over six months. In patients with a Karnofsky score of 50 to 70 (needing help with activities of daily living and unable to work, but not needing admission to hospital) diarrhoea was reduced by 50%. Remission was obtained in 26% of all patients who received albendazole (P=0.004 against 9% receiving placebo), and this difference was maintained over six months (log rank test, P=0.003). Albendazole had no effect on mortality. Minimal adverse effects were noted.

Conclusions: For HIV infected Zambians with diarrhoea of more than three weeks' duration albendazole offers substantial relief from symptoms and may be used empirically, without prior investigation.

Key messages

  • Enteric intracellular protozoa can be identified in most of these patients in hospital in Lusaka

  • Albendazole (800 mg twice daily for two weeks) reduced the time with diarrhoea over six months

  • The Karnofsky score, a simple clinical assessment, identified patients most likely to benefit

  • Albendazole had no measurable effect on mortality

Footnotes

  • Funding SmithKline Beecham for financial support and provision of drugs.

  • Conflict of interest None.

  • Accepted 27 February 1996
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