Adverse Reactions to Thalidomide in Patients Infected with Human Immunodeficiency Virus

Abstract

Thalidomide is emerging as a useful agent in the management of several complications of disease due to human immunodeficiency virus (HIV). We conducted three prospective studies of 56 HIV-infected patients who were treated with thalidomide for 14-21 days; 24 (43%) of these patients discontinued therapy owing to adverse reactions. Cutaneous and/or febrile reactions were the most frequent toxicities, arising in 20 (36%) of the patients. These reactions occurred after a mean interval (+/-SD) of 10 +/- 3 days and were associated with significantly lower CD4 T lymphocyte counts in reactors than in nonreactors (median count, 52.5/mm3 vs. 242 cells/mm3, respectively; P = .009). Four of four rechallenged patients experienced accelerated hypersensitivity; hypotension occurred in one case. Although sedation was an almost universal side effect among the patients, it was moderate or severe in only seven (13%); constipation was moderate or severe in five (9%) of the patients. Severe neuropathic symptoms and mood changes were each noted in two (4%) of the 56 patients. We conclude that the increasing use of thalidomide to treat HIV-infected patients must be accompanied by recognition of the drug's increased potential for toxicity in this population.

Thalidomide Treatment for Prurigo Nodularis in Human Immunodeficiency Virus –Infected Subjects

“…[25][26][27] Thalidomide use in subjects with AIDS who have aphthous ulcers 41 and wasting syndrome 10 has not been reported to result in TPN. In contrast, Wulff et al 27 suggested that with longterm treatment (1-6 years) in PN, all subjects develop signs of neuropathy.…”

“…3,4 In HIVinfected subjects, thalidomide has been used to treat cachexia 10,11 and oral aphthous ulcers. 12 Thalidomide is associated with teratogenicity (phocomelia), [13][14][15] peripheral neuropathy, [16][17][18][19][20] and drug reactions.…”

“…12 Thalidomide is associated with teratogenicity (phocomelia), [13][14][15] peripheral neuropathy, [16][17][18][19][20] and drug reactions. 10,[21][22][23] Because drug reactions and peripheral neuropathies are prevalent in HIV-infected subjects 24 and because peripheral neuropathies have been reported in up to 70% of immunocompetent patients with PN, [25][26][27] this study is particularly relevant in examining the efficacy and safety of thalidomide in a group of HIV-infected individuals with PN.…”

Reacción febril tras toma de talidomida

“…Los datos de algunas investigaciones sugieren que los infectados por el virus VIH sufren una mayor incidencia de efectos secundarios al seguir un tratamiento con talidomida que los VIH n e g a t i v o s 4 . Uno de los efectos descritos en los VIH positivos es la aparición de reacciones de hipersensibilidad caracterizadas por la presencia de rash y/o fieb r e 4 .…”

“…Uno de los efectos descritos en los VIH positivos es la aparición de reacciones de hipersensibilidad caracterizadas por la presencia de rash y/o fieb r e 4 . Por tanto, hay evidencia de que la talidomida puede producir fiebre de forma aislada en pacientes VIH y reacciones de hipersensibilidad con fiebre y rash tanto en infectados por el virus como en seronegativos, pero son muy escasas las publicaciones médicas (búsqueda en la base de datos Micromedex y Medline desde enero de 1984 hasta 1999) en las que sean descritos casos de fiebre de forma aislada en pacientes VIH negativos 5,6 .…”