[Intolerance to sulfonamides in HIV infected subjects. Toxic and allergic origin].
Intolerance to sulfonamides is very frequent in HIV-infected subjects and 10 times more common than in the general population. There are 2 types of intolerance to sulfonamides: early reactions with urticaria or angioedema, which are IgE-dependent, and late reactions with febrile rash, which occur between the 6th and 12th days of treatment and represent the vast majority of allergic manifestations in HIV-infected subjects. Clinically, these reactions resemble serum sickness, but all physiopathological hypotheses point to toxic process. The degradation of sulfonamides has two different pathways: the N-acetylation pathway which is genetically determined and saturable, and the cytochrome P450 pathway which produces toxic hydroxylamine metabolites "detoxified" by glutathione. In HIV-infected subjects detoxication is thought to be incomplete due to an acquired deficiency of glutathione and probably increased in the presence of a slow acetylation profile.
Mathelier-Fusade
P
P
Service Médecine interne, Hôpital Rothschild, Paris.
Leynadier
F
F
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D003875:Drug Eruptions / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000517:prevention & control*; D013411:Sulfadiazine / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D014123:Toxoplasmosis / Q000150:complications / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use
D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Intolérance aux sulfamides chez les sujets infectés par le VIH. Origine toxique et allergique.