Inosine pranobex - is a single positive trial enough?

Article Abstract:

In the June 21, 1990 issue of The New England Journal of Medicine, Pederson and colleagues report the use of inosine pranobex in the treatment of patients infected with human immunodeficiency virus (HIV), the virus that causes AIDS, who have not yet developed symptoms of AIDS. Their results suggest that the drug can delay the onset of AIDS, but further research will be necessary to determine how long the disease might be delayed and what doses are most effective. However, there are several features of the study which are disconcerting. Although the onset of AIDS was delayed, there were no differences in several immunological parameters that might have distinguished the treated group from the placebo group. For example, there were no differences between the groups in the number of T-cells with the CD4 antigen, nor were there any differences in the level of p24 viral antigen in the blood. In the absence of any real understanding of how inosine pranobex works, the positive results of this study must be interpreted cautiously. Furthermore, the authors of the paper do not bother to discuss previous studies using the drug, which resulted in less definitive results. As more drugs come under investigation for efficacy in treating HIV-infected patients, it is necessary that claims for any single agent be fully evaluated before decisions by the Food and Drug Administration and the medical community may be made. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, HIV (Viruses), HIV, AIDS virus carriers, HIV carriers, editorial, Isoprinosine

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Radiographic distribution of Pneumocystis carinii pneumonia in patients with AIDS treated with prophylactic inhaled pentamidine

Article Abstract:

Acquired immunodeficiency syndrome (AIDS) leaves its victims very susceptible to developing and dying from Pneumocystis carinii pneumonia. An aerosol form of the drug pentamidine is used to prevent this infection. It has been noted that patients using this drug may develop recurrent infections in the upper lobes of their lungs. To further investigate this, 64 AIDS patients with Pneumocystis carinii pneumonia (PCP) were studied; 23 of these patients used pentamidine; 41 did not use the drug and were considered the control group. All but one of the patients using the pentamidine improved with this therapy. Lung X-rays were analyzed for signs of pneumonia before and after therapy was begun; the upper, middle, and lower zones of the lungs were examined. The patients who were on pentamidine were more likely to show disease in the upper zone of the lung, but less likely to show disease in the middle and lower zones. The reason for this is not clear, but it is hypothesized that the monthly inhaled dose of pentamidine clears faster from the upper lobe, leaving this portion of the lung more susceptible to infection. Since the pentamidine is such a successful prophylactic treatment for this infection, a better understanding of how to improve its effectiveness is important. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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Aerosolized pentamidine: approved for HIV-infected individuals at high risk for Pneumocystis carinii pneumonia

Article Abstract:

Individuals infected with human immunodeficiency virus (HIV) are often victims of secondary opportunistic infections. One of the most deadly and worrisome of these for AIDS patients is a form of pneumonia caused by the protozoa Pneumocystis carinii. The United States Food and Drug Administration has approved the use of pentamidine isethionate as a preventive treatment for this disease in high-risk patients. The drug is administered in a aerosol mist every four weeks. The drug was released on the basis of results of a clinical trial involving 400 patients. The application work and clinical trials were performed by a community-based group of physicians, which is unusual. The mode of action of the drug is not known, and there are serious side effects in a reported 8.7 percent of patients who undergo treatment by pentamidine via injection. Specific groups of patients, including diabetics and patients with kidney disease, should be closely monitored during treatment. The potential risk to staff members, particularly if pregnant, from inadvertent exposure to the drug during the treatment of patients is unknown.

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