CRYPTOSPORIDIOSIS NEWS

Infections of the intestinal parasite Cryptosporidium can be extremely debilitating, causing abdominal cramping, watery stools, weight loss and fatigue. A recent report from Columbia University (Roberts, 1989) describes Cryptosporidium in patients who did not have any symptoms, suggesting that some people might be carriers, and the possibility that even if the protozoan is found in people with HIV who have diarrhea, cryptosporidiosis might not necessarily be the cause.

Last June, AIDS TREATMENT NEWS published a report on the drug diclazuril, a possible treatment for cryptosporidiosis (Issue #80). Diclazuril is available for agricultural use under the trade name Clinicox, and human trials have been proceeding to determine efficacy and toxicity.

We contacted each of the three diclazuril study sites in New York, and found results which are preliminary yet hopeful. Douglas Dieterich, M. D. of New York University, Rosemary Soave, M. D. of Cornell University and Donald Kotler, M. D. at Columbia University St. Luke's/Roosevelt Hospital Center have found that so far the drug has reduced Cryptosporidium oocyst counts in some participants at doses ranging from 200 mg to 400 mg, given daily for one week. No side effects have been noted; doses below 200 mg did not affect cyst counts. Some participants also reported a reduction in the frequency and volume of diarrhea, but this observation is not yet statistically significant. They plan to initiate a 600 mg dose as well as a 28-day protocol, with the rationale that a higher or longer dose regimen may improve the results.

They are also recruiting for a study of hyper-immune milk to treat cryptosporidiosis. In addition, Dr. Kotler's office is conducting a study of a salicylic acid compound called asacol to treat non-specific HIV-related bowel inflammation, and Dr. Soave is studying the efficacy of the investigational antibiotic spiramycin, given intravenously. To participate in one of these trials, interested persons can call the site of their preference: St. Luke's/Roosevelt at 212/523-3671, New York University at 212/986-3330, or Cornell at 212/746-6319.

Researchers at the University of Texas in Houston have proposed that eflornithine (DFMO), which is active against Pneumocystis, may alleviate some of the symptoms of cryptosporidiosis, and might work especially well if tried in conjunction with hyper-immune colostrum. The use of antibody-rich milk or colostrum from cows or goats which have been inoculated with Cryptosporidium has long been discussed as a possibility for treating such infections in people with HIV. In January of 1988 AIDS TREATMENT NEWS #49 mentioned this idea along with several other promising approaches to cryptosporidiosis, including AZT, trimetrexate with leucovorin (sometimes discussed as a treatment for PCP), spiramycin, somatostatin, Artemesia annua (an herb reportedly used successfully to treat malaria which will not respond to antibiotics), and garlic.

Spiramycin is available on a compassionate use basis and has been shown to reduce cyst counts and the severity of diarrhea in some people. Somatostatin and AZT can also relieve some diarrhea but can not eliminate the infection. We have not heard any substantial news regarding the other treatments, except for scattered rumors that large amounts of garlic may help control both cryptosporidiosis and toxoplasmosis (each is caused by protozoa).

AIDS TREATMENT NEWS has received anecdotal reports of another treatment for cryptosporidiosis which is available in Mexico and now used by some PWA's in the U. S. The treatment is named mebeciclol, although it is not just one drug but actually three separate agents combined in one tablet.

We spoke to Ronald Woodroof, director of the Dallas Buyer's Club which has informally monitored people who have tried mebeciclol. The Dallas club has also monitored a French product called roxithromycin (see AIDS TREATMENT NEWS #75 for background information) used by its members who were looking for new treatments for cryptosporidiosis. Mr. Woodroof described to us anecdotal reports which suggest that neither mebeciclol nor roxithromycin alone were very effective at ridding the body of the parasites or even controlling the profuse diarrhea associated with cryptosporidiosis. But a specific combination of the two has apparently helped some people.

The combination as it has evolved so far concurrently applies roxithromycin twice a day for four weeks, and mebeciclol three times daily for two weeks. Roxithromycin comes in tablets of 150 mg, and mebeciclol, also in tablets, is composed of 60 mg of mebendazole, 200 mg of niclosamide, and 300 mg of tinidazole. The first two of these three are already approved in the U. S. to treat certain parasites. Mr. Woodroof noted that the combination usually increased diarrhea initially, possibly due to successful killing of the parasite colonies, but that within several days the diarrhea improved.

We want to emphasize the speculative nature of this treatment combination, yet make the information available to physicians and PWA's who have not had success otherwise dealing with this debilitating infection. As with any experimental therapy, we strongly advocate the supervision of a physician for administering and monitoring roxithromycin or mebeciclol. For more information, call the Dallas Buyer's Club at 214/826-7455.

Anyone who has had significant experience involving mebeciclol, roxithromycin, spiramycin, hyper-immune milk, diclazuril or other attempts to treat cryptosporidiosis is encouraged to write to AIDS TREATMENT NEWS or call Denny or John at 415/255-0588.

References

Roberts, W G and others. "Prevalence of cryptosporidiosis in patients undergoing endoscopy: evidence for an asymptomatic carrier state." AMERICAN JOURNAL OF MEDICINE, November 1989, volume 87, number 5, pages 537-539.

Rolston, K V I and others. Intestinal cryptosporidiosis treated with eflornithine: a prospective study among patients with AIDS. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, October 1989, volume 2, number 5, pages 426-430.