Failure of Prophylaxis with Dapsone in Patients Taking Dideoxyinosine

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Abstract
Both dapsone (25 mg by mouth four times a day) and trimethoprim–sulfamethoxazole (160 mg of the former and 800 mg of the latter by mouth twice a day) are highly effective in preventing PCP in patients with HIV infection1 (and Metroka CE, et al.: unpublished data). In a previous report, only 2 of 162 patients had PCP while taking dapsone during a mean follow-up period of 9.6 months (range, 2 to 43) (Metroka CE, et al.: unpublished data). From December 7, 1989, to February 21, 1991, 66 patients were enrolled in the Videx (dideoxyinosine) treatment investigational-new-drug and open-label studies of dideoxyinosine, sponsored by Bristol-Myers. Nine patients could not be evaluated because of noncompliance or the development of adverse reactions to dideoxyinosine in the first 30 days. All the 57 patients who could be evaluated had less than 200 CD4+ cells per cubic millimeter at the initiation of therapy with dideoxyinosine and were receiving prophylaxis for PCP. PCP developed in 11 of the 28 patients receiving dapsone, in none of the 17 receiving trimethoprim–sulfamethoxazole, and in 1 of the 12 receiving 300 mg of aerosolized pentamidine monthly. Of the 12 patients in whom prophylaxis failed, 4 of those receiving dapsone and the 1 receiving pentamidine died of respiratory failure. The mean time from the beginning of dideoxyinosine treatment to the development of pneumocystis infection was 66 days (range, 10 to 130). Seventeen other patients have been receiving dideoxyinosine and dapsone for up to 14 months, without the development of PCP.

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