Prophylaxis of opportunistic infections

Hypersensitivity of HIV-1-Infected Cells to Reactive Sulfonamide Metabolites Correlated to Expression of the HIV-1 Viral Protein Tat

Impairment of human immunodeficiency virus (HIV)-infected cells to deal with reactive drug metabolites may be a mechanism for the increased rate of adverse drug reactions seen in AIDS. HIV Tat protein expression may be associated with increased oxidative stress within HIV-infected cells. To determine the relationship between expression of HIV Tat and sensitivity to reactive drug metabolites, we studied toxicity of sulfamethoxazole (SMX) and its reactive hydroxylamine intermediate (SMX-HA) in lymphocytes transfected with the HIV tat gene. Over a concentration range from 0 to 400 microM SMX-HA, there was a significant concentration-dependent increase in cell death in transfected cell lines expressing Tat compared with controls. Jurkat T cells transfected with a dose-dependent inducible tat gene showed increased toxicity in response to SMX-HA as more Tat expression was induced. Enhanced sensitivity to SMX-HA was accompanied by significantly lower concentrations of total intracellular glutathione compared with controls (P < 0.05). Sensitivity to reactive drug metabolites in HIV-infected cells seems to be mediated by the viral protein Tat.

Sinopulmonary complications of illicit drug use

Illicit drug use is frequently complicated by sinopulmonary illnesses. These complications fall into two major categories: (1) direct effects of drug exposure, and (2) indirect effects caused by HIV-induced immunosuppression. This article reviews the more common sinopulmonary syndromes associated with illicit drug use.