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Gastropathy and ketoconazole malabsorption in the acquired immunodeficiency syndrome (AIDS)
G Lake-Bakaar1, W Tom, D Lake-Bakaar
1State University of New York Health Science Center, Brooklyn.
Study Objective:
To correlate oral ketoconazole absorption with gastric acid secretion in patients with the acquired immunodeficiency syndrome (AIDS).
Design:
Prospective measurement of maximal acid output and oral ketoconazole absorption with and without 0.1-N hydrochloric acid.
Setting:
Hospital in-patients in university medical center.
Patients:
Ten consecutive male patients with AIDS.
Intervention:
Maximal acid output was determined after pentagastrin stimulation in all patients. Serum ketoconazole levels were measured the day after ingestion of a 200-mg ketoconazole tablet in the fasted state. On the final day, ketoconazole was ingested with 200 mL of 0.1-N hydrochloric acid.
Measurements And Main Results:
Maximal acid output was below 15 mEq/h in 7 of 10 patients. In all 7, the area under the serum ketoconazole concentration-time curve was below normal (1.4 +/- 0.9 mg/h.L; mean +/- SE), and absorption was normalized by hydrochloric acid (9.9 +/- mg/h.L). Two of three patients with maximal acid outputs above 15 mEq/h had normal ketoconazole absorption (15.1 +/- 6.7 mg/h.L).
Conclusions:
The bioavailability of oral ketoconazole is reduced in patients with AIDS, largely as a result of gastric hypochlorhydria. Ketoconazole tablets should therefore be given with acid in these patients.
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