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Trimethoprim-sulfamethoxazole associated neutropenia in Mexican HIV patients: a cohort study

  • At: PPR 2022 (2022)
  • Type: Poster
  • By: JACOBO VARGAS, Thalia Berenice (National Institute of Respiratory Diseases Ismael Cosío Villegas)
  • Co-author(s): Thalia Berenice Jacobo Vargas, Pharmacist, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico
    A. Renata Báez Saldaña, Head of the Oncological Pneumology Department, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico
    Gustavo Reyes Terán, Coordinating Commissioner for National Institutes of Health and High Specialty Hospitals, Coordinating Commission of National Institutes of Health and High Specialty Hospitals, Mexico
    Luis Pablo Cruz Hervert, Head of the Division of Graduate Studies and Research, School of Dentistry, National Autonomous University of Mexico, Mexico
    Victor Hugo Ahumada Topete, Head of the Department of Hospital Epidemiology and Infectious Diseases, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico
    Teresa Fortoul Van de Goes, Coordinator of the Master's and Doctoral Programme in Medical and Dental Sciences, National Autonomous University of Mexico, Mexico

  • Abstract:

    Introduction
    Trimethoprim-sulfamethoxazole (TMP-SMX) is the prophylactic and therapeutic regimen of first choice against Pneumocystis jirovecci pneumonia in immunocompromised patients, especially in people living with human immunodeficiency virus (HIV). Neutropenia is a known adverse drug reaction associated with TMP-SMX; however, it has been poorly documented in Mexican HIV patients.

    Purpose
    To identify the risk of TMP-SMX-associated neutropenia in patients living with HIV in Mexico.

    Methods
    A prospective cohort study was conducted in adults living with HIV admitted to a tertiary care hospital between August 2019 and March 2020. Socio-demographic, clinical and laboratory data were collected from the clinical record during patients' hospitalisation and from monthly follow-up calls from hospital discharge to the end of the study. Risk was quantified with multivariate robust Poisson regression analysis. Incidence rate ratio (IRR) with 95% confidence interval was used to measure the strength of association.

    Results
    57 patients were included in the cohort, of whom 24.6% (n=14) were treatment-experienced, 56.1% (n= 32) had opportunistic infection during follow-up, and 75.4% (n= 43) were in HIV infection category C3 at hospital admission. 17 patients were in the TMP-SMX exposed group (204.8 person-years of observation, median 12 days), and 40 patients were in the non-exposed group (87.0 person-years of observation, median 29 days). The incidence rate of neutropenia in the TMP-SMX exposed group versus the non-exposed group was 7.8 and 1.1 cases per 100 person-years, respectively. Current use of TMP-SMX was associated with more than 6-fold increase in the incidence rate of neutropenia (adjusted IRR: 6.68; 95% CI: 1.09-40.86; p= 0.040) adjusted for concomitant ganciclovir or valganciclovir exposure, glomerular filtration rate < 60 ml/min, and sepsis during hospitalisation.

    Conclusions
    Current use of TMP-SMX in Mexican patients living with HIV was independently associated with increased incidence rate of neutropenia. Further evidence needs to be generated as the clinical consequences of TMP-SMX associated neutropenia are unknown; however, early adjustment of drug therapy and timely initiation of granulocyte colony-stimulating factors to prevent neutropenia or its aggravation could have a positive impact on the outcome of patients.

Last update 4 October 2019

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