Increased risk of toxoplasmic encephalitis in human immunodeficiency virus-infected patients with pyrimethamine-related rash. ANRS 005-ACTG 154 Trial Group. Agence Nationale de Recherche sur le SIDA (ANRS-INSERM) and the NIAID-AIDS Clinical Trials Group.
Although drug-induced rash is frequent in human immunodeficiency virus (HIV)-infected patients, rash due to pyrimethamine has not been described previously. In a randomized, double-blind, placebo-controlled study of pyrimethamine as primary prophylaxis for toxoplasmic encephalitis, the incidence of rash (per hundred patient-years) was 8.1 in the pyrimethamine group versus 1.5 in the placebo group (P < .0002). The 1-year incidence of toxoplasmic encephalitis after occurrence of rash was 37%, as compared with 9.6% in the pyrimethamine group without rash, with a 3.7 times higher risk for patients with pyrimethamine-induced rash (P = .001); the incidence was 13% in the placebo group. At the time of toxoplasmic encephalitis, pyrimethamine was successfully readministered to 80% of patients who discontinued it because of rash. Thus, pyrimethamine, when used for prophylaxis, does induce rash in HIV-infected patients. These patients are at higher risk for toxoplasmic encephalitis and should be carefully monitored for it.
Rousseau
F
F
Hôpital Bichat-Claude Bernard, Université Paris 7, France.
Pueyo
S
S
Morlat
P
P
Hafner
R
R
Chène
G
G
Leport
C
C
Luft
B J
BJ
Miro
J
J
Aubertin
J
J
Salamon
R
R
Vildé
J L
JL
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000981:Antiprotozoal Agents / Q000009:adverse effects*; D018450:Disease Progression; D004311:Double-Blind Method; D003875:Drug Eruptions / Q000209:etiology*; D004660:Encephalitis / Q000517:prevention & control; D015658:HIV Infections / Q000503:physiopathology; D006801:Humans; D011739:Pyrimethamine / Q000009:adverse effects*; D012307:Risk Factors; D016781:Toxoplasmosis, Cerebral / Q000517:prevention & control*
D000981:Antiprotozoal Agents; D011739:Pyrimethamine