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Folate deficiency and cotrimoxazole prophylaxis during HIV infection.
Int Conf AIDS. 1993 Jun 6-11; 9: 387 OBJECTIVE: To evaluate the effect of long-term cotrimoxazole (TMP/SMX) prophylaxis on folate metabolism. METHODS: Open study concerns HIV1 seropositive adults, not supplemented with folic or folinic acid, at risk for Pneumocystis carinii pneumonia (CD4 count below 200/mm3 or < 20%), receiving since at least 3 months TMP/SMX (160 mg/800 mg twice a day) or aerosolized pentamidine (group control). Patients with initial low serum or/and erythrocyte folate level were excluded. RESULTS: Patients of the two groups (41 in TMP/SMX group, 36 in pentamidine group) were comparable for clinical features, initial CD4 count, zidovudine treatment and follow-up duration (3-26 months, mean 13). In group receiving TMP/SMX, severe folate deficiency (serum folate < 4 nmol/ml and/or erythrocyte folate < 300 nmol/ml) was observed in 15% (6 cases, all with wasting syndrome). Severe folate deficiency was not observed in pentamidine group (p < 0.05). CONCLUSION: These findings suggest that folinic acid should not be systematically added to prophylactic regimens using cotrimoxazole, except for patients with wasting syndrome.
