Trimethoprim-sulfamethoxazole and hypouricemia.
BACKGROUND
Hypouricemia has been reported in a substantial fraction of patients with AIDS and attributed to an HIV-related renal urate transport defect. We tested the alternative hypothesis that hypouricemia was associated with the administration of high-dose trimethoprim-sulfamethoxazole (TMP-SMX).


METHODS
Sociodemographic, clinical, and repeated laboratory data on 45 hospitalized patients with Pneumocystis carinii pneumonia (PCP) with and without HIV infection, were abstracted by a blinded reviewer. The primary outcome of interest was the percent change in serum uric acid concentration from baseline to hospital day 5 +/- 1.


RESULTS
Subjects who received TMP-SMX were older (mean age 44.8 vs. 37.0, p = 0.02), less likely to be HIV-seropositive (61% vs. 94%, p = 0.01), and more likely to have received glucocorticoid therapy (75% vs. 35%, p = 0.01) than those who received pentamidine, dapsone-trimethoprim, clindamycin-primaquine, sulfadiazine-pyramethamine, or a combination of these agents. The administration of TMP-SMX was associated with a 37% +/- 12% reduction in serum uric acid concentration, adjusting for the effects of age, sex, race, HIV antibody status, renal function, serum sodium, and the use of diuretics and glucocorticoids (p = 0.005).


CONCLUSIONS
Among a diverse cohort of hospitalized patients with PCP, treatment with high-dose TMP-SMX was strongly associated with a reduction in serum uric acid concentration over time.
Chertow
G M
GM
Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Seifter
J L
JL
Christiansen
C L
CL
O'Donnell
W J
WJ
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000150:complications; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*; D014527:Uric Acid / Q000097:blood*
D000890:Anti-Infective Agents; D014527:Uric Acid; D015662:Trimethoprim, Sulfamethoxazole Drug Combination