Crossover of human immunodeficiency virus-infected patients from aerosolized pentamidine to trimethoprim-sulfamethoxazole: lack of hematologic toxicity and relationship of side effects to CD4+ lymphocyte count.
Trimethoprim-sulfamethoxazole (TMP/SMZ) was given in a crossover study to 130 human immunodeficiency virus-infected patients who had been receiving aerosolized pentamidine; 86 (66%) successfully crossed over to TMP/SMZ without hypersensitivity reactions or hematologic toxicity. No significant changes occurred in mean hemoglobin concentration, leukocyte count, or platelet count between study enrollment and 12-month follow-up. Predominant side-effects, in 41 patients (33.8%), were fever and maculopapular rashes, which resolved promptly with discontinuation of TMP/SMZ. The mean time to first side effect was 12.3 days, and 86% of side effects developed within 30 days. Three patients experienced toxicity serious enough to warrant hospitalization. Of patients with < or = 200 CD4+ lymphocytes/mm3, 57% developed rashes after the cross-over compared with only 27% of patients with higher CD4+ cell counts. Many patients currently receiving aerosolized pentamidine can be safely crossed over without hematologic toxicity or hypersensitivity reactions.
Kennedy
C A
CA
Department of Internal Medicine (Division of Infectious Diseases), Naval Hospital, San Diego, CA 92134-5000.
Pimentel
J A
JA
Lewis
D E
DE
Anderson
M D
MD
Weiss
P J
PJ
Oldfield
E C
EC
D000328:Adult; D000336:Aerosols; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010419:Pentamidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013420:Sulfamethoxazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014295:Trimethoprim / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000336:Aerosols; D004338:Drug Combinations; D010419:Pentamidine; D014295:Trimethoprim; D013420:Sulfamethoxazole