Aerosol pentamidine prophylaxis following Pneumocystis carinii pneumonia in AIDS patients: results of a blinded dose-comparison study using an ultrasonic nebulizer

Article Abstract:

Pneumocystis carinii pneumonia (PCP) was early recognized to occur frequently in AIDS patients. Many times it recurs and often leads to death. The drug pentamidine was found to help prevent such recurrences. Given orally, it was found to cause severe side effects in many patients, so an aerosol method of delivery was developed. This method used a nebulizing (misting) device that gave a continuous flow of the drug. Studies using this method found it to be safe and effective and it is widely used today. Whether it was the best delivery method or whether other aerosol delivery methods might give better results was not studied. Another aerosol delivery method, the Fisons ultrajet nebulizer, was evaluated for prevention of recurrence of pneumonia in AIDS patients. This device is hand held, and delivers the drug on demand rather than in a continuous flow. It also delivers mist particles of a different size than the continuous flow method, which alters distribution of the drug in the lungs. It was tested in 175 AIDS patients who had had one bout of pneumocystis pneumonia. Three dosages were tested: 5 mg, 60 mg, and 120 mg every two weeks. After 24 weeks of treatment, seven patients in the 5 mg group had a relapse of PCP, none in the 60 mg group had a relapse, and three in the 120 mg group had a relapse. The patients in the 5 mg group were reassigned to the other two groups because the early results indicated it was an ineffective dose. The study then continued for another 28 weeks. Final results revealed that 88 percent of the patients receiving the 60 mg dose and 93 percent receiving the 120 mg dose did not have a relapse of PCP. This compares to relapse rates of 60 percent when no treatment is given. Mild side effects occurred in 5 percent of the patients. This aerosol method is both safe and effective. It compares favorably with the more commonly used nebulizer because it uses a lower dose, and the hand-held delivery system is easier to use and will probably cost less. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV infection, Drug therapy, HIV infections, Pneumocystis carinii pneumonia, Dosage and administration

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Course and prognosis of human immunodeficiency virus-associated nephropathy

Article Abstract:

Recent literature has described an unusual form of renal (kidney) disease in patients with the human immunodeficiency virus (HIV) that causes AIDS. This condition, HIV-associated nephropathy, is marked by large quantities of protein in the urine, rapid progression to renal failure and focal segmental glomerulosclerosis (FSGS, fibrosis and scarring of the capillaries in the kidney's filtering system). The clinical features and course of disease of 26 patients with HIV infection and FSGS and 24 patients with HIV infection but no glomerular disease were compared at autopsy. The data indicate that FSGS associated with HIV infection can occur before other symptoms of AIDS, is more common among blacks and intravenous drug abusers, and causes patients to progress rapidly to uremia (accumulation in the blood of waste that would normally be excreted by the kidney). The survival rates of these patients depend upon the stage of HIV infection at the time of diagnosis; patients with AIDS survived an average of 1.9 months and those who were initially asymptomatic carriers of HIV lived approximately 10 months. Patients with newly diagnosed renal disease should be screened for HIV infection. Dialysis is required for patients with HIV-associated nephropathy. Kidney transplantation is not recommended in HIV-positive patients; HIV screening is routine for organ donors and recipients. It is not known if some of the more recently developed medical therapies to treat AIDS will affect the development of renal nephropathy.

Usage, HIV (Viruses), HIV, Dialysis, Dialysis (Chemical process)

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Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AIDS

Article Abstract:

Pentamidine is a drug that has increasingly been used to treat and prevent Pneumocystis carinii pneumonia (PCP), an opportunistic infection which frequently occurs in association with AIDS. A case is reported of a 28-year-old man with AIDS who developed very low blood levels of calcium and magnesium after treatment with pentamidine. The patient had a past history of syphilis, brain infection, rectal herpes infection, and a medication-associated fever. On admission, PCP was diagnosed and the patient was given pentamidine intravenously. Acute kidney failure developed on the fourth day of pentamidine treatment, and muscular and other symptoms associated with low blood magnesium and calcium levels developed on the tenth day. Calcium and magnesium supplements were given for two weeks, and systemic pentamidine therapy was discontinued on the tenth day due to kidney failure. Pentamidine was administered as an inhalant form, and the patient improved. Three months after the episode, calcium and magnesium levels were close to normal. Although kidney failure has been observed in 23 to 95 percent of patients treated with systemic pentamidine, this is the first report of pentamidine-associated kidney magnesium wasting. Other causes of hypomagnesemia, such as hypoparathyroidism, disturbed vitamin D metabolism, or pancreatitis were excluded in this patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Hypocalcemia

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