Clinical and laboratory markers of hypersensitivity to trimethoprim-sulfamethoxazole in patients with Pneumocystis carinii pneumonia and AIDS

J Infect Dis. 1993 Jan;167(1):180-5. doi: 10.1093/infdis/167.1.180.


A group of clinical, immunologic, and virologic variables was examined to determine if any predicted the development of hypersensitivity to trimethoprim-sulfamethoxazole (TMP-SMZ) during treatment of Pneumocystis carinii pneumonia in patients with human immunodeficiency virus (HIV) infection. Hypersensitivity occurred in 39 (27%) of 143 patients, who had significantly higher total lymphocyte and CD4+ and CD8+ cell counts and CD4:CD8 ratios than did those who did not develop hypersensitivity. Regression analysis identified having a CD4:CD8 ratio > 0.10 (95% confidence interval [CI], 1.75-3.94; P = .02) and treatment for < 14 days (95% CI, 1.57-3.75; P = .04) as independently predictive of hypersensitivity. Use of corticosteroids tended to reduce the frequency of hypersensitivity (7% vs. 30%; P = .07). T lymphocytes may be important in the pathogenesis of these hypersensitivity reactions. As the frequency of hypersensitivity declines with disease progression, T lymphocytes could be effector cells in these reactions or their sensitivity to TMP-SMZ may decline with HIV disease progression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / immunology*
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antibodies, Viral / analysis
  • CD4-CD8 Ratio
  • Cytomegalovirus Infections / immunology
  • Drug Hypersensitivity / etiology*
  • Humans
  • Immunoglobulins / analysis
  • Male
  • Middle Aged
  • Pneumonia, Pneumocystis / drug therapy
  • Pneumonia, Pneumocystis / immunology*
  • Regression Analysis
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects*


  • Adrenal Cortex Hormones
  • Antibodies, Viral
  • Immunoglobulins
  • Trimethoprim, Sulfamethoxazole Drug Combination