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Uveitis Associated with Rifabutin Prophylaxis
- Diane Havlir, MD;
- Francesca Torriani, MD; and
- Michael Dube, MD
- From the University of California San Diego, San Diego, California; the Los Angeles County Medical Center, University of Southern California, Los Angeles, California. Requests for Reprints: Diane Havlir, MD, University of California, San Diego, Treatment Center, 2760 Fifth Avenue, Suite 300, San Diego, CA 92103. Acknowledgments: The authors thank Dr. P.K. Narang for helping with the pharmacokinetics analysis; Drs. Kirsch, Peterson, and Kimberly, and Ms. Kathy Nuffer, for providing data on their patients; Drs. J. Allen McCutchan and R. Haubrich for giving their thoughtful comments on this manuscript; and Ms. Abbe Cavender for providing technical assistance. Grant Support: In part by the California Universitywide AIDS Research Program through the California Collaborative Treatment Group. Dr. Torriani is supported by the Swiss National Foundation for AIDS Research. The rifabutin serum levels were paid for by Pharmacia-Adria, Dublin, Ohio.
The U.S. Public Health Task Force recommends rifabutin prophylaxis (300 mg daily) for the prevention of Mycobacterium avium complex infection in patients with human immunodeficiency virus (HIV) infection who have less than 100 CD4 cells/mm3[1, 2]. Rifabutin is reported to be well tolerated at daily doses of 300 mg or less [1, 3]; at doses greater than 1.5 g daily, rifabutin can cause uveitis and an arthralgia-arthritis syndrome [4]. Uveitis has also been observed in patients receiving lower doses (600 mg daily) of rifabutin for disseminated M. avium complex infection and in one patient receiving rifabutin (300 mg daily) as prophylaxis against such infection [5-7]. We report four additional cases of uveitis in patients infected with HIV who were receiving prophylaxis against M. avium complex infection; all four cases occurred after 7 months of therapy.
Case Reports
The demographic characteristics, clinical presentations, and outcomes of patients are shown in Table 1.
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Case patients were participants in a randomized, double-blind study of M. avium complex and deep fungal prophylaxis. During the study, all patients reported having …
