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Adverse Effects of Drugs Used in the Management of Opportunistic Infections Associated with HIV Infection

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Summary

Pneumocystis carinii pneumonia (PCP) is one of the most common AIDS-defining diagnoses. First-line therapy is cotrimoxazole (trimethoprim-sulfamethoxazole), despite a high incidence of toxic effects, and a greater incidence of hypersensitivity reactions among HIV-positive patients compared with the seronegative population. Alternative agents such as intravenous pentamidine, or clindamycin with primaquine, and trimethoprim with dapsone, also have a wide range of serious adverse effects, but remain treatment options.

Atovaquone appears promising for the treatment of both PCP and toxoplasmosis, and has a lower reported incidence of toxicity than the alternative agents.

The most toxic antifungal drugs are reserved for serious infections, such as cryptococcal meningitis. Liposomal amphotericin B has less renal toxicity than standard formulations, and exemplifies that new formulations of existing drugs, although often expensive, may have a better adverse effect profile.

There are 2 different drugs currently available for cytomegalovirus (CMV) infections, ganciclovir and foscarnet. Both have a high incidence of serious adverse effects; ganciclovir mainly causes bone marrow toxicity and foscarnet leads to renal toxicity.

The drugs used for mycobacterial infection (including mycobacteria as well as tuberculosis) have a wide range of adverse effects, particularly skin rashes and drug-induced hepatitis. Some of these compounds are quite new, such as rifabutin and clarithromycin, and it is important to be ever vigilant for previously unreported adverse effects.

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  1. Academic Department of Genitourinary Medicine and Communicable Diseases, Department of Genitourinary Medicine, Department of Pharmacy and Department of Medicine, St Mary’s Hospital, London, England

    Barry S. Peters, Elizabeth Carlin, Jonathan Weber & Janice Main

  2. Department of Immunology, St Bartholomew’s Hospital, London, England

    John Sweeney

  3. Pharmacy Department, St Mary’s Hospital, London, England

    Rosemary J. Weston & Susan J. Loveless

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Peters, B.S., Carlin, E., Weston, R.J. et al. Adverse Effects of Drugs Used in the Management of Opportunistic Infections Associated with HIV Infection. Drug-Safety 10, 439–454 (1994). https://doi.org/10.2165/00002018-199410060-00003

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