Dapsone/Pyrimethamine May Prevent Mycobacterial Disease in Immunosuppressed Patients Infected with the Human Immunodeficiency Virus

Opravil, Milos ; Pechère, Marc ; Lazzarin, Adriano ; Heald, Alison ; Rüttimann, Sigmund ; Iten, Anne ; Furrer, Hansjakob ; Oertle, Daniel ; Praz, Gerard ; Vuitton, Dominique A. ; Hirschel, Bernard ; Lüthy, Ruedi

In: Clinical Infectious Diseases, 1995, vol. 20, no. 2, p. 244-249

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    Summary
    Dapsone exhibits activity against Mycobacterium tuberculosis and Mycobacterium avium complex (MAC) in vitro. We retrospectively examined the incidence of mycobacterial diseases within a randomized prospective trial of prophylaxis for Pneumocystis carinii pneumonia and toxoplasmosis. Of 501 participants who had not previously had a mycobacterial disease, 274 received dapsone/pyrimethamine (200/75 mg once weekly) and 227 received aerosolized pentamidine (300 mg once every 4 weeks). The median CD4 lymphocyte count was 113/µL, and the median duration of treatment was 369 days. Six cases of tuberculosis, 22 of MAC infection, and 3 of Mycobacterium genavense disease occurred during treatment. Stratified by baseline CD4 lymphocyte counts, the annual product-limit incidence of mycobacterial disease was 5% during treatment with dapsone/pyrimethamine vs. 12% during treatment with aerosolized pentamidine for patients whose counts were 0-24/µL, 0 vs. 12% for those whose counts were 25-49/µL, and 7% vs. 9% for those whose counts were 50-99/µL. Adjusted for CD4 lymphocyte counts at start of treatment, the relative risk for patients receiving dapsone/pyrimethamine was 0.47 (95% confidence interval, 0.19-1.16; P = .10). This inexpensive and simple regimen may prevent mycobacterial diseases and warrants further investigation as a means of prophylaxis for multiple opportunistic diseases