DESENSITIZATION TO TRIMETHOPRIM-SULFAMETHOXAZOLE IN HIV-INFECTED PATIENTS

Background: Trimethoprim-sulfamethoxazole (T/S) is art effective and i mportant prophylactic medication for HIV-infected patients that must f requently be discontinued because of allergic reactions. Objective: Ou t objective was to assess the safety, the frequency of success, and th e duration of desensitization to T/S in HIV-infected patients. Method: We studied oral desensitization with T/S of patients with a history o f allergy to the medication and longitudinal follow-up. Twenty-eight m en with a history of T/S-induced skin rashes were studied. Mean age wa s 35 years (range, 26 to 50 years). Mean CD4 count was 89 cells/mm(3) (range, 0/mm(3) to 210/mm(3)). patients were seen every 4 to 6 weeks. Mean follow-up was 19.07 week (range 2 to 81 weeks). Results: After 32 weeks, 23 of 28 (82%) patients were successfully desensitized (four h ad rashes develop, and one could not continue for personal reasons). O f the 23 patients who were successfully desensitized, six were known t o have subsequently discontinued T/S (four had rashes; two discontinue d on the advice of their personal primary physicians). Six patients we re lost to follow-up. One patient died of pulmonary Kaposi's sarcoma. ren patients are taking the medication regularly without any problems. Conclusion: T/S desensitization is a simple, safe and effective means to provide it for most patients with a history of ''allergic'' rashes .