ADVERSE REACTIONS TO THALIDOMIDE IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Thalidomide is emerging as a useful agent in the management of several complications of disease due to human immunodeficiency virus (HIV). W e conducted three prospective studies of 56 HIV-infected patients who were treated with thalidomide for 14-21 days; 24 (43%) of these patien ts discontinued therapy owing to adverse reactions. Cutaneous and/or f ebrile reactions were the most frequent toxicities, arising in 20 (36% ) of the patients. These reactions occurred after a mean interval (+/- SD) of 10 +/- 3 days and were associated with significantly lower CD4 T lymphocyte counts in reactors than in nonreactors (median count, 52. 5/mm(3) vs. 242 cells/mm(3), respectively; P =.009). Four of four rech allenged patients experienced accelerated hypersensitivity; hypotensio n occurred in one case. Although sedation was an almost universal side effect among the patients, it was moderate or severe in only seven (1 3%); constipation was moderate or severe in five (9%) of the patients. Severe neuropathic symptoms and mood changes were each noted in two ( 4%) of the 56 patients, We conclude that the increasing use of thalido mide to treat HIV-infected patients must be accompanied by recognition of the drug's increased potential for toxicity in this population.