BLEOMYCIN-INDUCED RAYNAUDS-SYNDROMES IN H IV-1-ASSOCIATED KAPOSI-DISEASE

OBJECTIVES: Raynaud's syndromes may be observed in HIV-infected patien ts, particularly those with Kaposi disease treated with bleomycin. Thi s complication occurs in 10% of patients given bleomycin although only 7 cases have been reported in the literature. The aim of this study w as to determine the frequency of certain biological abnormalities obse rved in HIV patients with Kaposi disease given bleomycin and who devel op Raynaud's syndromes. PATIENTS AND METHODS: A survey was conducted f rom 1989 to 1995 among 1074 patients infected with HIV-1. There were 1 21 patients with Kaposi disease and 73 or these were treated with bleo mycin. The clinical features and laboratory results (cryoglobulinemia, free protein-S, protein-C, anticardiolipin antibodies, von Willebrand factor (vWF.ag), endothelin-1) were obtained in 5 patients who develo ped bleomycin-induced Raynaud's syndrome. RESULTS: Amont the 73 patien ts with Kaposi disease treated with bleomycin (total mean dose = 227 m g (120-380 mg)), 5 patients (12.6%) developed a severe Raynaud's synch rome including two who suffered digital necrosis. Withdrawal of bleomy cin led to improved symptomatology (n = 2) or an aggravation (n = 1) i n the 3 patients followed. CONCLUSION: Raynaud's syndromes are frequen t (12.6%) in HIV patients with Kaposi disease treated with bleomycin. The vascular toxicity of bleomycin, demonstrated in animals, would app ear to be the causal factor among others. Release of endothelial facto rs (vWF.ag, endothelin-1) and perturbed hemostasis related to the HIV infection (protein-S deficiency, anticardiolipin antibodies) could be an expression of and aggravate the vascular toxicity of bleomycin.