{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:03:58Z","timestamp":1783350238652,"version":"3.54.6"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020950","name":"National Council of Science and Technology","doi-asserted-by":"crossref","award":["CVU 1196087"],"award-info":[{"award-number":["CVU 1196087"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Trimethoprim\/sulfamethoxazole (TMP\/SMX) is the antimicrobial of first choice in the treatment and prophylaxis of <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PCP) in immunocompromised patients, particularly in people living with human immunodeficiency virus (HIV). TMP\/SMX use entails different adverse effects, and its association with early neutropenia is minimally documented. This study aimed to identify the risk of early neutropenia associated with TMP\/SMX use in adults living with HIV in Mexico.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A prospective cohort study was conducted in TMP\/SMX-na\u00efve adults living with HIV admitted to a third-level hospital between August 2019 and March 2020. Socio-demographic, clinical, and laboratory data were collected. According to patients\u2019 diagnostic, if they required treatment or prophylaxis against PCP, medical staff decided to prescribe TMP\/SMX, as it is the first-line treatment. The risk of TMP\/SMX induced early neutropenia, as well as associated factors were analyzed through a bivariate model and a multivariate Poisson regression model. The strength of association was measured by incidence rate ratio (IRR) with 95% confidence interval.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>57 patients were enrolled in the study, of whom 40 patients were in the TMP\/SMX treatment-group for treatment or prophylaxis of PCP (204.8 person-years of observation, median 26.5 days) and 17 patients were in the non-treatment group because they did not need the drug for treatment or prophylaxis of PCP (87.0 person-years of observation, median 21 days). The incidence rate of early neutropenia in the TMP\/SMX-treatment group versus non-treatment group was 7.81 and 1.15 cases per 100 person-years, respectively. After adjusting for stage 3 of HIV infection and neutrophil count &lt;1,500 cells\/mm<jats:sup>3<\/jats:sup> at hospital admission, the current use of TMP\/SMX was not associated with an increase in the incidence rate ratio of early neutropenia (adjusted IRR: 3.46; 95% CI: 0.25\u201347.55; p = 0.352).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The current use of TMP\/SMX in Mexican adults living with HIV was not associated with an increase in the incidence rate ratio of early neutropenia.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285541","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T17:37:23Z","timestamp":1683826643000},"page":"e0285541","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Trimethoprim-Sulfamethoxazole-associated early neutropenia in Mexican adults living with HIV: A cohort study"],"prefix":"10.1371","volume":"18","author":[{"given":"Thalia Berenice","family":"Jacobo-Vargas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9582-1666","authenticated-orcid":true,"given":"Renata","family":"B\u00e1ez-Salda\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Pablo","family":"Cruz-Hervert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Imelda","family":"Fortoul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-3496","authenticated-orcid":true,"given":"Victor Hugo","family":"Ahumada-Topete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odalis","family":"Rodr\u00edguez-Gan\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Stanley","family":"Vega-Barrientos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"issue":"2","key":"pone.0285541.ref001","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1055\/s-0036-1579556","article-title":"Pneumocystis jirovecii Pneumonia in Human Immunodeficiency Virus Infection","volume":"37","author":"M Siegel","year":"2016","journal-title":"Semin Respir Crit Care Med"},{"issue":"2","key":"pone.0285541.ref002","first-page":"77","article-title":"CROI 2017: Complications and Comorbidities of HIV Disease and Its Treatment","volume":"25","author":"JS Currier","year":"2017","journal-title":"Top Antivir Med"},{"issue":"3","key":"pone.0285541.ref003","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1473-3099(14)71011-4","article-title":"The expanding role of co-trimoxazole in developing countries","volume":"15","author":"JA Church","year":"2015","journal-title":"Lancet Infect Dis"},{"key":"pone.0285541.ref004","first-page":"1","article-title":"Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America","volume":"58","author":"JE Kaplan","year":"2009","journal-title":"MMWR Recomm Rep"},{"key":"pone.0285541.ref005","unstructured":"Spanish Agency of Medicines and Medical Devices (AEMPS). 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