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Safety of aerosol pentamidine prophylaxis for PCP on the endocrine pancreatic function in HIV-patients.
Le Fouilie-Ribeyre C; Kaloustian E; Veyssier P; Internal Medicine
November 30, 1993
Int Conf AIDS. 1993 Jun 6-11;9(1):377 (abstract no. PO-B10-1452). Unique

Pancreatic side effects have been described with Pentamidine curative treatment for pneumocystis carinii pneumonia (PCP). We assessed the pancreatic beta-cells functions of HIV-patients receiving either 300 mg/month aerosolized Pentamidine (n = 12) or oral trimethoprime-sulfamethoxazole (TMP:160 mg, SM:800 mg twice a day three times/week, n = 10). All fully informed patients were in CDC stage III or IV. Intra-veinous glucose tolerance tests were performed: after IV injection of 0.5 g/kg BW glucose in 30 seconds, plasma insulin levels were assessed at baseline, 3 and 5 mn. Moreover, in patients receiving inhaled Pentamidine, plasma glucose, amylase and insulin levels were measured every 30 mn for 2 hours after the beginning of the aerosol therapy. Plasma Pentamidine levels were measured 30 mn after the end of the aerosol treatment. Those tests were performed every 2-3 months for one year. In all patients, pentamidine levels were detectable, but under toxic levels (50 ng/ml). Pentamidine plasma levels increased in a time-dependant manner: 1.8 ng/ml at 3 month, 2.5 at 6 month, 4.7 at 9 month, 5.7 at 12 month, 8.1 at 18 month, 8.4 after 18 months. Baseline plasma glucose, amylase and insulin levels were normal, and remain stable during the treatment. For 8/12 patients, glucose tolerance tests showed a adequate insulin secretion: the addition of insulin levels at 3 and 5 mn were higher than 70 IU/ml. When this criteria was not found (n = 4), a glucagon stimulation test allowed to exclude a endocrine pancreatic dysfunction. Because of a short half-life, increased pentamidine levels are probably related to an improvement of spray techniques rather than a cumulative effect. Pancreatic functions were preserved in pentamidine-treated patients compared to TMP-SM-treated patients. In conclusion, in this 12 month study, our results suggest the absence of side effects in preventive nebulised pentamidine treatment on endocrine pancreatic function.

*AIDS-Related Opportunistic Infections/PREVENTION & CONTROL *Insulin/BLOOD *Islets of Langerhans/DRUG EFFECTS *Pentamidine/ADVERSE EFFECTS *Pneumonia, Pneumocystis carinii/PREVENTION & CONTROL