Trimethoprim-Sulfamethoxazole-associated early neutropenia in Mexican adults living with HIV: A cohort study.

Autor: Jacobo-Vargas TB; Pharmacist in Pharmacology Research Unit and Hospital Pharmacy Department, National Institute of Respiratory Diseases, Mexico City, Mexico.; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, National Autonomous University of Mexico, Mexico City, Mexico., Báez-Saldaña R; Hospitalization, National Institute of Respiratory Diseases, Mexico City, Mexico., Cruz-Hervert LP; Professor of Orthodontic Department in the Division of Postgraduate Studies and Research, Faculty of Dentistry, National Autonomous University of Mexico, Mexico City, Mexico.; Program on Epidemiological and Emerging Risks, National Autonomous University of Mexico, Mexico City, Mexico., Fortoul TI; School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico., Ahumada-Topete VH; Head of the Unit of Hospital Epidemiology and Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico., Rodríguez-Ganén O; Head of the Hospital Pharmacy Department, National Institute of Respiratory Diseases, Mexico City, Mexico., Vega-Barrientos RS; Hospitalization, National Institute of Respiratory Diseases, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 May 11; Vol. 18 (5), pp. e0285541. Date of Electronic Publication: 2023 May 11 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0285541
Abstrakt: Introduction: Trimethoprim/sulfamethoxazole (TMP/SMX) is the antimicrobial of first choice in the treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients, particularly in people living with human immunodeficiency virus (HIV). TMP/SMX use entails different adverse effects, and its association with early neutropenia is minimally documented. This study aimed to identify the risk of early neutropenia associated with TMP/SMX use in adults living with HIV in Mexico.
Methods: A prospective cohort study was conducted in TMP/SMX-naïve adults living with HIV admitted to a third-level hospital between August 2019 and March 2020. Socio-demographic, clinical, and laboratory data were collected. According to patients' diagnostic, if they required treatment or prophylaxis against PCP, medical staff decided to prescribe TMP/SMX, as it is the first-line treatment. The risk of TMP/SMX induced early neutropenia, as well as associated factors were analyzed through a bivariate model and a multivariate Poisson regression model. The strength of association was measured by incidence rate ratio (IRR) with 95% confidence interval.
Results: 57 patients were enrolled in the study, of whom 40 patients were in the TMP/SMX treatment-group for treatment or prophylaxis of PCP (204.8 person-years of observation, median 26.5 days) and 17 patients were in the non-treatment group because they did not need the drug for treatment or prophylaxis of PCP (87.0 person-years of observation, median 21 days). The incidence rate of early neutropenia in the TMP/SMX-treatment group versus non-treatment group was 7.81 and 1.15 cases per 100 person-years, respectively. After adjusting for stage 3 of HIV infection and neutrophil count <1,500 cells/mm3 at hospital admission, the current use of TMP/SMX was not associated with an increase in the incidence rate ratio of early neutropenia (adjusted IRR: 3.46; 95% CI: 0.25-47.55; p = 0.352).
Conclusions: The current use of TMP/SMX in Mexican adults living with HIV was not associated with an increase in the incidence rate ratio of early neutropenia.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Jacobo-Vargas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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