Interactions and toxicities of drugs used in patients with AIDS

As clinicians have come to realize, patients who have AIDS are uniquely predisposed to drug-associated toxic effects and allergic reactions. In San Francisco General Hospital's first clinical trial involving patients with pneumonia due to Pneumocystis carinii, only one-third of all patients who were treated initially with either trimethoprim-sulfamethoxazole or pentamidine were able to complete the 3-week course. Because of drug-related toxic effects, most patients required an alteration in therapy. In addition, with the multi-drug approach to management of infection due to human immunodeficiency virus (HIV) and its complications, drug-drug interactions commonly complicate the pharmacokinetics and toxicities of the therapeutic agents used. Both factors make caring for HIV-infected patients a complicated and perplexing process for the clinician. We've invited Drs. Belle Lee and Sharon Safrin of the University of California, San Francisco School of Medicine to contribute the AIDS Commentary this month. Drs. Lee and Safrin are active investigators in the field of pharmacokinetics and conduct clinical trials of agents used in the treatment of patients who have AIDS. In this commentary, they review what is known about the complexities involved in treating patients with AIDS and offer some practical suggestions for management.