Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects

Yvo M. Smulders, Angelique M.E. Spoelstra-de Man, Ed H. Slaats, Hugo M. Weigel, Coen D.A. Stehouwer, P. H. Jos Frissen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8±7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm3). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6±2.2 and 5.3±3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9±3.7 μmol/l pre-treatment and 14.4±5.0 μmol/l during treatment with TMP-SMX, a non-significant increase of 0.5 μmol/l (95% CI: -0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1±6.5 nmol/l versus 13.3±5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.

Original languageEnglish
Pages (from-to)363-365
Number of pages3
JournalEuropean Journal of Internal Medicine
Volume12
Issue number4
DOIs
Publication statusPublished - 1 Jan 2001

Cite this

@article{768c0dfa7c0f43019798bdd1d44bd0f4,
title = "Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects",
abstract = "Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8±7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm3). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6±2.2 and 5.3±3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9±3.7 μmol/l pre-treatment and 14.4±5.0 μmol/l during treatment with TMP-SMX, a non-significant increase of 0.5 μmol/l (95{\%} CI: -0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1±6.5 nmol/l versus 13.3±5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.",
keywords = "Acquired immunodeficiency syndrome, HIV infection, Homocysteine, Pneumocystis carinii, Prophylaxis, Trimethoprim, Trimethoprim-sulphamethoxazole",
author = "Smulders, {Yvo M.} and {Spoelstra-de Man}, {Angelique M.E.} and Slaats, {Ed H.} and Weigel, {Hugo M.} and Stehouwer, {Coen D.A.} and {Jos Frissen}, {P. H.}",
year = "2001",
month = "1",
day = "1",
doi = "10.1016/S0953-6205(01)00134-0",
language = "English",
volume = "12",
pages = "363--365",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier",
number = "4",

}

Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects. / Smulders, Yvo M.; Spoelstra-de Man, Angelique M.E.; Slaats, Ed H.; Weigel, Hugo M.; Stehouwer, Coen D.A.; Jos Frissen, P. H.

In: European Journal of Internal Medicine, Vol. 12, No. 4, 01.01.2001, p. 363-365.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects

AU - Smulders, Yvo M.

AU - Spoelstra-de Man, Angelique M.E.

AU - Slaats, Ed H.

AU - Weigel, Hugo M.

AU - Stehouwer, Coen D.A.

AU - Jos Frissen, P. H.

PY - 2001/1/1

Y1 - 2001/1/1

N2 - Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8±7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm3). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6±2.2 and 5.3±3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9±3.7 μmol/l pre-treatment and 14.4±5.0 μmol/l during treatment with TMP-SMX, a non-significant increase of 0.5 μmol/l (95% CI: -0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1±6.5 nmol/l versus 13.3±5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.

AB - Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8±7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm3). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6±2.2 and 5.3±3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9±3.7 μmol/l pre-treatment and 14.4±5.0 μmol/l during treatment with TMP-SMX, a non-significant increase of 0.5 μmol/l (95% CI: -0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1±6.5 nmol/l versus 13.3±5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.

KW - Acquired immunodeficiency syndrome

KW - HIV infection

KW - Homocysteine

KW - Pneumocystis carinii

KW - Prophylaxis

KW - Trimethoprim

KW - Trimethoprim-sulphamethoxazole

UR - http://www.scopus.com/inward/record.url?scp=0034963259&partnerID=8YFLogxK

U2 - 10.1016/S0953-6205(01)00134-0

DO - 10.1016/S0953-6205(01)00134-0

M3 - Article

VL - 12

SP - 363

EP - 365

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

IS - 4

ER -