The risk of hypersensitivity reactions to trimethoprim/sulfamethoxazole as a function of the CD4+ count in HIV-infected patients

Susan J. Morikawa, Linda M. Cortese, Janet S. Walker, Charles N. Oster, Jose Stoute

Research output: Contribution to journalArticle

Abstract

Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is an important antibiotic for the treatment and prevention of opportunistic infections in patients infected with HIV. However, the high rate of hypersensitivity reactions in this population of patients significantly limits the use of this drug. Objective: To determine whether early initiation of Pneumocystis carinii pneumonia prophylaxis with TMP/SMX in patients with HIV whose CD4+ lymphocyte count is >200 cells/mm3 results in a decrease the number of hypersensitivity reactions. Methods: Retrospective cohort study. The main outcomes measured were the number of and the time to hypersensitivity reactions. Results: There were 134 patients who met the eligibility criteria (62 with a CD4+ cell count ≤200 cells/mm3 and 72 with a CD4+ cell count >200 cells/mm3). Overall, 47 (35.1%) patients had adverse reactions including 29 (21.6%) episodes of hypersensitivity. The mean time to a hypersensitivity reaction for the group with a CD4+ cell count ≤200 cells/mm3 was 155 days and for the group with a CD4+ cell count >200 cells/mm3 it was 261 days (mean difference = 106; p = 0.07; 95% CI 66 to 146 days). The number of episodes of hypersensitivity reactions was similar among the two groups: 15 (24.2%) and 14 (19.4%), respectively (p = O.5; relative risk for CD4+ cell count ≤200 cells/mm3 = 1.14; 95% CI 0.7 to 1.7). Log- rank test did not reveal a significant difference in reaction-free survival among the groups (p = 0.3). Conclusions: Our data suggest that initiation of P. carinii pneumonia prophylaxis with TMP/SMX at a CD4+ cell count >200 cells/mm3 would lead to prolongation of the mean time to a hypersensitivity reaction, but would not significantly decrease the risk of a reaction over time.

Original languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalJournal of Pharmacy Technology
Volume15
Issue number5
DOIs
StatePublished - Jan 1 1999

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Sulfamethoxazole Drug Combination Trimethoprim
CD4 Lymphocyte Count
Hypersensitivity
HIV
Pneumocystis Pneumonia
Opportunistic Infections
Cohort Studies
Retrospective Studies
Anti-Bacterial Agents
Survival
Pharmaceutical Preparations
Population

All Science Journal Classification (ASJC) codes

  • Pharmaceutical Science

Cite this

Morikawa, Susan J. ; Cortese, Linda M. ; Walker, Janet S. ; Oster, Charles N. ; Stoute, Jose. / The risk of hypersensitivity reactions to trimethoprim/sulfamethoxazole as a function of the CD4+ count in HIV-infected patients. In: Journal of Pharmacy Technology. 1999 ; Vol. 15, No. 5. pp. 165-169.
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abstract = "Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is an important antibiotic for the treatment and prevention of opportunistic infections in patients infected with HIV. However, the high rate of hypersensitivity reactions in this population of patients significantly limits the use of this drug. Objective: To determine whether early initiation of Pneumocystis carinii pneumonia prophylaxis with TMP/SMX in patients with HIV whose CD4+ lymphocyte count is >200 cells/mm3 results in a decrease the number of hypersensitivity reactions. Methods: Retrospective cohort study. The main outcomes measured were the number of and the time to hypersensitivity reactions. Results: There were 134 patients who met the eligibility criteria (62 with a CD4+ cell count ≤200 cells/mm3 and 72 with a CD4+ cell count >200 cells/mm3). Overall, 47 (35.1{\%}) patients had adverse reactions including 29 (21.6{\%}) episodes of hypersensitivity. The mean time to a hypersensitivity reaction for the group with a CD4+ cell count ≤200 cells/mm3 was 155 days and for the group with a CD4+ cell count >200 cells/mm3 it was 261 days (mean difference = 106; p = 0.07; 95{\%} CI 66 to 146 days). The number of episodes of hypersensitivity reactions was similar among the two groups: 15 (24.2{\%}) and 14 (19.4{\%}), respectively (p = O.5; relative risk for CD4+ cell count ≤200 cells/mm3 = 1.14; 95{\%} CI 0.7 to 1.7). Log- rank test did not reveal a significant difference in reaction-free survival among the groups (p = 0.3). Conclusions: Our data suggest that initiation of P. carinii pneumonia prophylaxis with TMP/SMX at a CD4+ cell count >200 cells/mm3 would lead to prolongation of the mean time to a hypersensitivity reaction, but would not significantly decrease the risk of a reaction over time.",
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The risk of hypersensitivity reactions to trimethoprim/sulfamethoxazole as a function of the CD4+ count in HIV-infected patients. / Morikawa, Susan J.; Cortese, Linda M.; Walker, Janet S.; Oster, Charles N.; Stoute, Jose.

In: Journal of Pharmacy Technology, Vol. 15, No. 5, 01.01.1999, p. 165-169.

Research output: Contribution to journalArticle

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T1 - The risk of hypersensitivity reactions to trimethoprim/sulfamethoxazole as a function of the CD4+ count in HIV-infected patients

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N2 - Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is an important antibiotic for the treatment and prevention of opportunistic infections in patients infected with HIV. However, the high rate of hypersensitivity reactions in this population of patients significantly limits the use of this drug. Objective: To determine whether early initiation of Pneumocystis carinii pneumonia prophylaxis with TMP/SMX in patients with HIV whose CD4+ lymphocyte count is >200 cells/mm3 results in a decrease the number of hypersensitivity reactions. Methods: Retrospective cohort study. The main outcomes measured were the number of and the time to hypersensitivity reactions. Results: There were 134 patients who met the eligibility criteria (62 with a CD4+ cell count ≤200 cells/mm3 and 72 with a CD4+ cell count >200 cells/mm3). Overall, 47 (35.1%) patients had adverse reactions including 29 (21.6%) episodes of hypersensitivity. The mean time to a hypersensitivity reaction for the group with a CD4+ cell count ≤200 cells/mm3 was 155 days and for the group with a CD4+ cell count >200 cells/mm3 it was 261 days (mean difference = 106; p = 0.07; 95% CI 66 to 146 days). The number of episodes of hypersensitivity reactions was similar among the two groups: 15 (24.2%) and 14 (19.4%), respectively (p = O.5; relative risk for CD4+ cell count ≤200 cells/mm3 = 1.14; 95% CI 0.7 to 1.7). Log- rank test did not reveal a significant difference in reaction-free survival among the groups (p = 0.3). Conclusions: Our data suggest that initiation of P. carinii pneumonia prophylaxis with TMP/SMX at a CD4+ cell count >200 cells/mm3 would lead to prolongation of the mean time to a hypersensitivity reaction, but would not significantly decrease the risk of a reaction over time.

AB - Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is an important antibiotic for the treatment and prevention of opportunistic infections in patients infected with HIV. However, the high rate of hypersensitivity reactions in this population of patients significantly limits the use of this drug. Objective: To determine whether early initiation of Pneumocystis carinii pneumonia prophylaxis with TMP/SMX in patients with HIV whose CD4+ lymphocyte count is >200 cells/mm3 results in a decrease the number of hypersensitivity reactions. Methods: Retrospective cohort study. The main outcomes measured were the number of and the time to hypersensitivity reactions. Results: There were 134 patients who met the eligibility criteria (62 with a CD4+ cell count ≤200 cells/mm3 and 72 with a CD4+ cell count >200 cells/mm3). Overall, 47 (35.1%) patients had adverse reactions including 29 (21.6%) episodes of hypersensitivity. The mean time to a hypersensitivity reaction for the group with a CD4+ cell count ≤200 cells/mm3 was 155 days and for the group with a CD4+ cell count >200 cells/mm3 it was 261 days (mean difference = 106; p = 0.07; 95% CI 66 to 146 days). The number of episodes of hypersensitivity reactions was similar among the two groups: 15 (24.2%) and 14 (19.4%), respectively (p = O.5; relative risk for CD4+ cell count ≤200 cells/mm3 = 1.14; 95% CI 0.7 to 1.7). Log- rank test did not reveal a significant difference in reaction-free survival among the groups (p = 0.3). Conclusions: Our data suggest that initiation of P. carinii pneumonia prophylaxis with TMP/SMX at a CD4+ cell count >200 cells/mm3 would lead to prolongation of the mean time to a hypersensitivity reaction, but would not significantly decrease the risk of a reaction over time.

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