Predicting cutaneous hypersensitivity reactions to cotrimoxazole in hiv-infected individuals receiving primary pneumocystis carinii pneumonia prophylaxis
- 34 Downloads
OBJECTIVES: To measure the incidence of cutaneous hypersensitivity reactions to cotrimoxazole in the setting of primaryPneumocystis carinii pneumonia (PCP) prophylaxis; to measure the incidence of severe reactions; and to identify predictors for these outcomes.
DESIGN: Retrospective cohort study.
SETTING: One university-based outpatient HIV clinic and one university-affiliated internal medicine and infectious disease medical practice.
PATIENTS: Two hundred thirty-six HIV-infected individuals receiving cotrimoxazole for primary PCP prophylaxis.
MAIN OUTCOME MEASURE: Occurrence of a cutaneous hypersensitivity reaction, defined as rash, fever, or pruritus that resulted in permanent discontinuation of cotrimoxazole. Severe reactions were defined as those resulting in hospital admission or systemic treatment with a corticosteroid. Cox regression was used to calculate relative rates (RRs) and 95% confidence intervals (CIs) for a number of clinical and laboratory variables.
MEASUREMENTS AND MAIN RESULTS: Forty-eight (20%) subjects developed cutaneous hypersensitivity reactions, with six (12.5%) of these being severe. In the unadjusted analysis, the following factors demonstrated at least borderline association: male gender [RR (95% CI)=0.46 (0.21–0.99)], higher CD4 percentage [RR (95% CI)=0.95 (0.90–1.00)], syphilis history [RR (95% CI)=0.37 (0.13–1.04)], and higher total protein [RR (95% CI)=0.70 (0.45–1.09)]. Adjustment for potential confounding by measured variables did not meaningfully change these results.
CONCLUSIONS: Cutaneous hypersensitivity reactions to cotrimoxazole in the setting of primary PCP prophylaxis are common. Although male gender, higher CD4 percentage, syphilis history, and higher total protein have at least borderline associations with these reactions, routinely collected clinical and laboratory variables do not appear to be sufficiently associated with the reactions to permit development of a clinically useful prediction rule.
Key wordsHIV Pneumocystis carinii pneumonia trimethoprim- sulfamethoxazole drug hypersensitivity risk factors prediction
Unable to display preview. Download preview PDF.
- 1.U.S. Public Health Service Task Force on Antipneumocystis Prophylaxis in Patients with Human Immunodeficiency Virus Infection. Recommendations for prophylaxis againstPneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. J Acquir Immune Defic Syndr. 1993;6:46–55.Google Scholar
- 3.Kennedy CA, Pimentel JA, Lewis DE, Anderson MD, Weiss PJ, Old- field EC. Crossover of human immunodeficiency virus—infected patients from aerosolized pentamidine to trimethoprim— sulfamethoxazole: lack of hematologic toxicity and a relationship of side effects to CD4+ lymphocyte count. J Infect Dis. 1993;168:314–7.PubMedGoogle Scholar
- 10.Cox DR. Regression models and life tables (with discussion). J R Stat Soc(B). 1972;34:187–220.Google Scholar