Rousseau F, Pueyo S, Morlat P, Hafner R, Chène G, Leport C, Luft B J, Miro J, Aubertin J, Salamon R, Vildé J L
Hôpital Bichat-Claude Bernard, Université Paris 7, France.
Clin Infect Dis. 1997 Mar;24(3):396-402. doi: 10.1093/clinids/24.3.396.
Although drug-induced rash is frequent in human immunodeficiency virus (HIV)-infected patients, rash due to pyrimethamine has not been described previously. In a randomized, double-blind, placebo-controlled study of pyrimethamine as primary prophylaxis for toxoplasmic encephalitis, the incidence of rash (per hundred patient-years) was 8.1 in the pyrimethamine group versus 1.5 in the placebo group (P < .0002). The 1-year incidence of toxoplasmic encephalitis after occurrence of rash was 37%, as compared with 9.6% in the pyrimethamine group without rash, with a 3.7 times higher risk for patients with pyrimethamine-induced rash (P = .001); the incidence was 13% in the placebo group. At the time of toxoplasmic encephalitis, pyrimethamine was successfully readministered to 80% of patients who discontinued it because of rash. Thus, pyrimethamine, when used for prophylaxis, does induce rash in HIV-infected patients. These patients are at higher risk for toxoplasmic encephalitis and should be carefully monitored for it.
虽然药物性皮疹在人类免疫缺陷病毒（HIV）感染患者中很常见，但此前尚未有关于乙胺嘧啶引起皮疹的描述。在一项关于乙胺嘧啶作为弓形虫性脑炎一级预防的随机、双盲、安慰剂对照研究中，乙胺嘧啶组皮疹发生率（每100患者年）为8.1，而安慰剂组为1.5（P < .0002）。皮疹出现后1年弓形虫性脑炎的发生率为37%，而乙胺嘧啶组无皮疹者为9.6%，乙胺嘧啶引起皮疹的患者风险高3.7倍（P = .001）；安慰剂组发生率为13%。在发生弓形虫性脑炎时，80%因皮疹而停用乙胺嘧啶的患者成功再次使用了该药。因此，乙胺嘧啶用于预防时确实会在HIV感染患者中引起皮疹。这些患者发生弓形虫性脑炎的风险更高，应予以密切监测。
