Glucuronidation and sulphation of paracetamol in HIV-positive patients andpatients with AIDS

Aims To gauge the effect of disease state and disease progression on the gl ucuronidation and sulphation of paracetamol (APAP) among HIV-positive patie nts and patients with AIDS. Methods The extent of APAP glucuronidation and APAP sulphation was assessed using a spot urine sample collected 4 h after the oral administration of 5 00 mg of APAP to 108 patients with AIDS or HIV infection. The molar concent rations of APAP and its glucuronide and sulphate metabolites were determine d using a validated h.p.l.c. method and glucuronidation and sulphation indi ces were constructed using APAP metabolite/APAP molar concentration ratios. Results No effect of disease state, AIDS vs asymptomatic HIV positive vs co ntrol, on APAP glucuronidation or sulphation was observed. The patient popu lation was studied over time and disease progression also did not significa ntly alter the calculated glucuronidation and sulphation indices. The effec t of the concomitant administration of other therapeutic agents was assesse d and in the cross sectional portion of the study dapsone appeared to signi ficantly decrease APAP sulphation as did lamivudine. In the longitudinal po rtion of the study the latter effect was not observed but zidovudine was se en to increase APAP glucuronidation. The data also indicates that APAP gluc uronidation may be reduced in patients who are > 10% below their ideal body weight.