       Document 0436
 DOCN  M9620436
 TI    Predicting cutaneous hypersensitivity reactions to cotrimoxazole in
       HIV-infected individuals receiving primary Pneumocystis carinii
       pneumonia prophylaxis.
 DT    9602
 AU    Hennessy S; Strom BL; Berlin JA; Brennan PJ; Center for Clinical
       Epidemiology and Biostatistics, University of; Pennsylvania School of
       Medicine, Philadelphia 19104-6095, USA.
 SO    J Gen Intern Med. 1995 Jul;10(7):380-6. Unique Identifier : AIDSLINE
       MED/96066065
 AB    OBJECTIVES: To measure the incidence of cutaneous hypersensitivity
       reactions to cotrimoxazole in the setting of primary Pneumocystis
       carinii pneumonia (PCP) prophylaxis: to measure the incidence of severe
       reactions: and to identify predictors for these outcomes. DESIGN:
       Retrospective cohort study. SETTING: One university-based outpatient HIV
       clinic and one university-affiliated internal medicine and infectious
       disease medical practice. PATIENTS: Two hundred thirty-six HIV-infected
       individuals receiving cotrimoxazole for primary PCP prophylaxis.
       INTERVENTIONS: None. MAIN OUTCOME MEASURE: Occurrence of a cutaneous
       hypersensitivity reaction, defined as rash, fever, or pruritus that
       resulted in permanent discontinuation of cotrimoxazole. Severe reactions
       were defined as those resulting in hospital admission or systemic
       treatment with a corticosteroid. Cox regression was used to calculate
       relative rates (RRs) and 95% confidence intervals (CIs) for a number of
       clinical and laboratory variables. MEASUREMENTS AND MAIN RESULTS:
       Forty-eight (20%) subjects developed cutaneous hypersensitivity
       reactions, with six (12.5%) of these being severe. In the unadjusted
       analysis, the following factors demonstrated at least borderline
       association: male gender [RR (95% CI) = 0.46 (0.21-0.99)], higher CD4
       percentage [RR (95% CI) = 0.95 (0.90-1.00)], syphilis history [RR (95%
       CI) = 0.37 (0.13-1.04)], and higher total protein [RR (95% CI) = 0.70
       (0.45-1.09)]. Adjustment for potential confounding by measured variables
       did not meaningfully change these results. CONCLUSIONS: Cutaneous
       hypersensitivity reactions to cotrimoxazole in the setting of primary
       PCP prophylaxis are common. Although male gender, higher CD4 percentage,
       syphilis history, and higher total protein have at least borderline
       associations with these reactions, routinely collected clinical and
       laboratory variables do not appear to be sufficiently associated with
       the reactions to permit development of a clinically useful prediction
       rule.
 DE    Adult  Aged  Anti-Infective Agents, Urinary/*ADVERSE EFFECTS  Antibiotic
       Prophylaxis/*ADVERSE EFFECTS  Cohort Studies  Drug
       Hypersensitivity/*ETIOLOGY  Female  Human  HIV Infections/*COMPLICATIONS
       Male  Middle Age  Pneumonia, Pneumocystis carinii/*PREVENTION & CONTROL
       Retrospective Studies  Risk Factors  Support, Non-U.S. Gov't  Support,
       U.S. Gov't, P.H.S.  Trimethoprim-Sulfamethoxazole Combination/*ADVERSE
       EFFECTS  JOURNAL ARTICLE

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

