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


METHODS
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.


CONCLUSIONS
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.
Nguyen
M T
MT
Department of Pharmacy, Naval Medical Center, San Diego, California 92134-5000, USA.
Weiss
P J
PJ
Wallace
M R
MR
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000284:Administration, Oral; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004342:Drug Hypersensitivity; D004361:Drug Tolerance; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000276:immunology / Q000517:prevention & control*; D011446:Prospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
D015662:Trimethoprim, Sulfamethoxazole Drug Combination