甲氧苄啶-磺胺甲恶唑相关的中性粒细胞减少症在墨西哥 HIV 成年感染者中的研究：一项队列研究。

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

机构信息

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.

出版信息

PLoS One. 2023 May 11;18(5):e0285541. doi: 10.1371/journal.pone.0285541. eCollection 2023.

DOI:10.1371/journal.pone.0285541

PMID:37167312

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10174569/

Abstract

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.

摘要

介绍

复方磺胺甲噁唑（TMP/SMX）是免疫功能低下患者中治疗和预防肺孢子菌肺炎（PCP）的首选抗菌药物，尤其适用于人类免疫缺陷病毒（HIV）感染者。TMP/SMX 的使用会带来不同的不良反应，其与早期中性粒细胞减少症的关联鲜有记载。本研究旨在确定 TMP/SMX 在墨西哥 HIV 感染者中的使用与早期中性粒细胞减少症相关的风险。

方法

这是一项在 2019 年 8 月至 2020 年 3 月期间在一家三级医院住院的 TMP/SMX 初治 HIV 感染者中进行的前瞻性队列研究。收集了社会人口统计学、临床和实验室数据。根据患者的诊断，如果需要治疗或预防 PCP，医务人员会决定开 TMP/SMX，因为它是一线治疗药物。通过单变量模型和多变量泊松回归模型分析 TMP/SMX 引起早期中性粒细胞减少症的风险及相关因素。关联强度用发病率比（IRR）及其 95%置信区间来衡量。

结果

本研究共纳入 57 例患者，其中 40 例患者因治疗或预防 PCP 而接受 TMP/SMX 治疗（204.8 人年的观察期，中位数 26.5 天），17 例患者因无需 TMP/SMX 治疗或预防 PCP 而处于非治疗组（87.0 人年的观察期，中位数 21 天）。TMP/SMX 治疗组与非治疗组的早期中性粒细胞减少症发生率分别为 7.81 和 1.15 例/100 人年。在校正 HIV 感染 3 期和入院时中性粒细胞计数<1500 个/立方毫米后，当前使用 TMP/SMX 与早期中性粒细胞减少症的发病率比增加无关（校正 IRR：3.46；95%CI：0.25-47.55；p=0.352）。