title: Efficacy and safety of desensitization with sulfamethoxazole and trimethoprim in 48 previously hypersensitive patients infected with human immunodeficiency virus.
abstract: OBJECTIVE
  To study the safety and efficacy of desensitization with the use of a combination product of sulfamethoxazole and trimethoprim in previously hypersensitive patients infected with the human immunodeficiency virus.
  
  
  METHODS
  Prospective survey, with a median follow-up of 16 months (range, 5-24 months).
  
  
  METHODS
  Day-care hospital in a referral center.
  
  
  METHODS
  All human immunodeficiency virus-infected patients who had a history of allergic reactions (eg, rash) to sulfamethoxazole-trimethoprim and who required sulfamethoxazole-trimethoprim prophylaxis.
  
  
  METHODS
  The desensitization procedure took 2 days. The full dose (sulfamethoxazole-trimethoprim, 400-80 mg) was reached on the third day according to the following schedule: day 1--4-0.8 mg at 9 AM, 8-1.6 mg at 11 AM, 20-4 mg at 1 PM, and 40-8 mg at 5 PM; day 2--80-16 mg at 9 AM, 160-32 mg at 3 PM, and 200-40 mg at 9 PM; and day 3--400-80 mg at 9 AM.
  
  
  METHODS
  The onset of cutaneous adverse effects attributable to sulfamethoxazole-trimethoprim therapy within 3 months after desensitization.
  
  
  RESULTS
  Of the 48 evaluable patients, 37 (77%) tolerated sulfamethoxazole-trimethoprim desensitization without toxic effects and continued to take sulfamethoxazole-trimethoprim daily. Desensitization failed in 11 cases (5 on day 1, 3 on day 2, and 1 each on days 9, 11, and 90). Acute hypotension and a nonfatal myocardial infarction developed in 1 of these patients. The factors that were predictive of failure were a relatively high CD4+ cell percentage (11% vs 8%; P = .008) and a relatively high CD4+/CD8+ ratio (0.27 vs 0.12; P = .02).
  
  
  CONCLUSIONS
  The efficacy of desensitization with sulfamethoxazole-trimethoprim was confirmed; this desensitization procedure was more often successful in patients with lower CD4+ cell percentages and CD4+/CD8+ ratios. However, sulfamethoxazole-trimethoprim therapy should be reintroduced carefully.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Caumes
authors.forename: G
authors.initials: G
authors.lastname: Guermonprez
authors.forename: C
authors.initials: C
authors.lastname: Lecomte
authors.forename: C
authors.initials: C
authors.lastname: Katlama
authors.forename: F
authors.initials: F
authors.lastname: Bricaire
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000276:immunology / Q000627:therapeutic use*; D003888:Desensitization, Immunologic; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000209:etiology / Q000628:therapy*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013420:Sulfamethoxazole / Q000276:immunology / Q000627:therapeutic use*; D014295:Trimethoprim / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D014295:Trimethoprim; D013420:Sulfamethoxazole