Document 0964
 DOCN  M94A0964
 TI    Survival, death, and desensitization to trimethoprim/sulfamethoxazole
       (TMP/SMX).
 DT    9412
 AU    King C; Slaton A; Okabe M; Conant M; Conant Medical Group: Research,
       University of California, San; Francisco.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(2):24 (abstract no. 388B). Unique
       Identifier : AIDSLINE ICA10/94371611
 AB    OBJECTIVE: To evaluate the safety and efficacy of
       trimethoprim/sulfamethoxazole (TMP/SMX) as a prophylatic agent in
       individuals who, previously exhibiting hypersensitivity to sulfa-based
       drugs, attempted a standard TMP/SMX desensitization protocol. Efficacy
       in this study was defined as successful completion of the protocol
       and/or no development of an initial or recurrent episode of PCP or
       toxoplasmosis. METHODS: Retrospective data collection and analysis of
       progress notes of 100 consecutive patients having attempted the standard
       TMP/SMX desensitization protocol. Patients had a documented history of
       at least one episode of hypersensitivity to TMP/SMX or other sulfa-based
       drug(s). All were attempting to initiate prophylaxis against
       Pneumocystis carinii pneumonia (PCP) for the first time, or change their
       current prophylaxis to TMP/SMX. All patients were included in this
       analysis regardless of prior PCP history or elevated toxoplasma titers
       (IgG,IgM). RESULTS: In the sample of 100 patients, 84 (group A) (84%)
       were successfully desensitized (defined as the ability to tolerate
       80mg-160mg TMP and 400mg-800mg SMX every day without rash, fever,
       itching, flu-like or other symptoms attributed to TMP/SMX). Only one
       (1.2%) of these patients in group A, developed both PCP and acute
       toxoplasmosis (toxoplasma titers on this patient indicate acute disease
       one month prior to initiation of the protocol). Of the remaining 16
       (group B) (16%) who were deemed protocol failures, eight (50%)
       subsequently developed PCP (and/or toxoplasmosis). Of these eight
       patients, two (25%) subsequently died of PCP. DATA ANALYSIS: In the
       original sample of 100 patients, 36 (36%) had a prior history of PCP
       (and/or elevated toxo titers). Of these 36 patients, 30 (83.3%) were
       successfully desensitized; of these, one patient developed PCP. Of the 6
       (16.7%) who failed the protocol, 4 (66.8%) of these patients developed
       PCP or acute toxo. One patient is still living 30 months after an
       initial bout with PCP and has been maintained on prophylactic TMP/SMX
       for 22 months without recurrence of PCP. CONCLUSION: This retrospective
       epidemiological study concludes that this standard desensitization
       protocol and subsequent therapy with TMP/SMX dramatically decreased the
       incidence of two life-threatening infections in those deemed a protocol
       success. As TMP/SMX remains the best prophylactic agent against the
       Pneumocystis organism, it follows that this desensitization protocol
       should be offered to all patients hypersensitive to TMP/SMX who are
       living with HIV infection.
 DE    Acquired Immunodeficiency Syndrome/MORTALITY  AIDS-Related Opportunistic
       Infections/*PREVENTION & CONTROL  *Desensitization, Immunologic  Drug
       Hypersensitivity/ETIOLOGY/*THERAPY  Human  Pneumonia, Pneumocystis
       carinii/MORTALITY/*PREVENTION & CONTROL  Retrospective Studies
       Toxoplasmosis/MORTALITY/*PREVENTION & CONTROL  Treatment Outcome
       Trimethoprim-Sulfamethoxazole Combination/ADVERSE EFFECTS/
       IMMUNOLOGY/*THERAPEUTIC USE  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).