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15 June 1994 | Volume 120 Issue 12 | Page 1048
Patients with human immunodeficiency virus (HIV) infection are unusually sensitive to chemical hepatitis caused by trimethoprim-sulfamethoxazole and pentamidine [1, 2]. Our anecdotal observations suggested a similar sensitivity of such patients to oxacillin. To examine this hypothesis, we compared all HIV-infected patients treated for bacterial endocarditis at our hospital between January 1991 and December 1992 with patients not known to be HIV-positive.
All patients received oxacillin therapy for at least 10 days or stopped therapy because of hepatotoxicity as defined by an increase in the aspartate or alanine aminotransferase levels to at least three times the upper limit of normal and by a return to normal levels after therapy was discontinued. We excluded patients with abnormal liver function test results or alcohol intoxication on admission.
Overall, 81% of the HIV-positive patients showed hepatotoxicity during oxacillin therapy compared with 4.5% in the comparison group (Table 1). The slightly higher mean dose in the HIV-positive group did not appear to account for the observed difference between HIV-negative and -positive patients. Only 1 of the 28 HIV-negative patients receiving 12 g of oxacillin daily showed hepatotoxicity. Moreover, no patient was positive for hepatitis B surface antigen or had chronic active hepatitis. Most patients had CD4 counts greater than 200 cells/mm3. LETTER
Oxacillin Hepatotoxicity in HIV-infected Patients
TO THE EDITOR:
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We do not know whether the hepatitis seen in these patients is immunologically or chemically mediated. It is known that the isoxazole ring of oxacillin can be degraded to 2-butanone and hydroxylamine [3]. It has been postulated that scavenging of hydroxylamine derivatives by glutathione is necessary to prevent cytotoxicity [4] and that HIV-positive patients have systemic glutathione deficiency [5]. Our results strongly support the conclusion that HIV-infected patients are susceptible to oxacillin hepatotoxicity.
Author and Article Information
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References
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TopAuthor & Article InfoReferences |
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1. Medina I, Mills J, Leoung G, Hopewell PC, Lee B, Modin G, et al. Oral therapy for Pneumocystis carinii pneumonia in the AIDS. N Engl J Med. 1990; 323:776-82.
2. Kovacs JA, Hiemenz JW, Macher AM, Stover D, Murray HW, Shelhamer J, et al.Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med. 1984; 100: 663-71.
3. Manzo RH. de Bertorello MM. Isoxazoles. II. Kinetics and mechanism of degradation of sulfisoxazole in moderately concentrated acids. J Pharm. Sci. 1973; 62:154-8.
4. van der Ven AJ, Koopmans PP, Vree TB, van der Meer JW. Adverse reactions to co-trimoxazole in HIV infection. Lancet. 1991; 338:431-3.
5. Buhl R, Jaffe HA, Holroyd KJ, Wells FB, Mastrangeli A, Saltini C, et al. Systemic glutathione deficiency in symptom-free HIV seropositive individuals. Lancet 1989; 2:1294-98.
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This article has been cited by other articles:
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  W. M. Lee Drug-Induced Hepatotoxicity N. Engl. J. Med., October 26, 1995; 333(17): 1118 - 1127. [Full Text] [PDF]
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