title: Dapsone/pyrimethamine may prevent mycobacterial disease in immunosuppressed patients infected with the human immunodeficiency virus.
abstract: Dapsone exhibits activity against Mycobacterium tuberculosis and Mycobacterium avium complex (MAC) in vitro. We retrospectively examined the incidence of mycobacterial diseases within a randomized prospective trial of prophylaxis for Pneumocystis carinii pneumonia and toxoplasmosis. Of 501 participants who had not previously had a mycobacterial disease, 274 received dapsone/pyrimethamine (200/75 mg once weekly) and 227 received aerosolized pentamidine (300 mg once every 4 weeks). The median CD4 lymphocyte count was 113/microL, and the median duration of treatment was 369 days. Six cases of tuberculosis, 22 of MAC infection, and 3 of Mycobacterium genavense disease occurred during treatment. Stratified by basement CD4 lymphocyte counts, the annual product-limit incidence of mycobacterial disease was 5% during treatment with dapsone/pyrimethamine vs. 12% during treatment with aerosolized pentamidine for patients whose counts were 0-24/microL, 0 vs. 12% for those whose counts were 25-49/microL, and 7% vs. 9% for those whose counts were 50-99/microL. Adjusted for CD4 lymphocyte counts at start of treatment, the relative risk for patients receiving dapsone/pyrimethamine was 0.47 (95% confidence interval, 0.19-1.16; P = .10). This inexpensive and simple regimen may prevent mycobacterial diseases and warrants further investigation as a means of prophylaxis for multiple opportunistic diseases.
authors.affiliation: University Hospital of Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Opravil
authors.forename: M
authors.initials: M
authors.lastname: Pechère
authors.forename: A
authors.initials: A
authors.lastname: Lazzarin
authors.forename: A
authors.initials: A
authors.lastname: Heald
authors.forename: S
authors.initials: S
authors.lastname: Rüttimann
authors.forename: A
authors.initials: A
authors.lastname: Iten
authors.forename: H
authors.initials: H
authors.lastname: Furrer
authors.forename: D
authors.initials: D
authors.lastname: Oertle
authors.forename: G
authors.initials: G
authors.lastname: Praz
authors.forename: D A
authors.initials: DA
authors.lastname: Vuitton
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003622:Dapsone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009164:Mycobacterium Infections / Q000517:prevention & control*; D015270:Mycobacterium avium-intracellulare Infection / Q000517:prevention & control; D009330:Nebulizers and Vaporizers; D010419:Pentamidine / Q000008:administration & dosage / Q000627:therapeutic use*; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D012189:Retrospective Studies; D016781:Toxoplasmosis, Cerebral / Q000517:prevention & control; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control
chemical_list: D010419:Pentamidine; D003622:Dapsone; D011739:Pyrimethamine