Two-day oral desensitization to trimethoprim-sulfamethoxazole in HIV-infected patients

AIDS. 1995 Jun;9(6):573-5. doi: 10.1097/00002030-199506000-00007.

Abstract

Objective: To establish whether an outpatient, 2-day oral desensitization protocol would be both safe and effective in HIV-infected patients with previous trimethoprim-sulfamethoxazole (TMP-SMX) intolerance.

Design: A single center trial of TMP-SMX desensitization in HIV-infected patients with prior TMP-SMX hypersensitivity reactions.

Methods: HIV-infected patients with CD4 lymphocyte counts < 250 x 10(6)/l cells or CD4% < 20% with previous non-life-threatening hypersensitivity reactions to TMP-SMX were eligible. The desensitization protocol utilized 40 graduated doses over 36 h; the first 28 doses (7.5 h) of the protocol were given in an outpatient clinic with the remaining doses taken at home.

Results: Twenty-seven (60%) of the 45 subjects completed the protocol and were subsequently maintained on daily TMP-SMX without adverse reactions (mean follow-up, 9 months; range, 4-16 months). Patients with CD4 counts < 100 x 10(6)/l cells were just as likely as patients with higher CD4 counts to tolerate the desensitization. No patient required hospitalization for treatment of an adverse reaction.

Conclusion: Oral desensitization to TMP-SMX in HIV-infected patients is a useful option in the management of patients with advanced HIV disease and prior intolerance to TMP-SMX.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control*
  • Administration, Oral
  • CD4-Positive T-Lymphocytes / immunology
  • Drug Hypersensitivity
  • Drug Tolerance
  • Humans
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / prevention & control*
  • Prospective Studies
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage*

Substances

  • Trimethoprim, Sulfamethoxazole Drug Combination