Adverse reactions to thalidomide in patients infected with human immunodeficiency virus.
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.
Haslett
P
P
Laboratory of Cellular Physiology and Immunology, Rockefeller University, New York, New York 10021-6399, USA.
Tramontana
J
J
Burroughs
M
M
Hempstead
M
M
Kaplan
G
G
D000328:Adult; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D005260:Female; D005334:Fever / Q000209:etiology; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012867:Skin / Q000187:drug effects; D013792:Thalidomide / Q000009:adverse effects*
D013792:Thalidomide