Seizures in HIV-Seropositive IndividualsEpidemiology and Treatment
作者:
Frank Romanelli,
Melody Ryan,
期刊:
CNS Drugs
(ADIS Available online 2002)
卷期:
Volume 16,
issue 2
页码: 91-98
ISSN:1172-7047
年代: 2002
出版商: ADIS
关键词: Anticonvulsants, drug interactions;Antiretrovirals, drug interactions;Drug interactions;HIV infections;Seizures
数据来源: ADIS
摘要:
Seizures are a relatively common occurrence in patients with HIV infection. They may be a result of HIV infection of the CNS or a manifestation of an opportunistic infection. Because seizures are likely to recur in patients infected with HIV and because they are a poor prognostic indicator, it is generally recommended that all HIV-seropositive patients experiencing a first seizure without a recognisable and reversible cause be treated. Clinicians faced with treating seizures in HIV-seropositive patients often encounter a therapeutic dilemma since few data exist in this area. In selecting appropriate anticonvulsant therapy, clinicians must consider both therapy-compromising drug-drug and drug-disease interactions. Ideal anticonvulsants for this setting are those that do not effect viral replication, have limited protein binding and have no effects on the cytochrome P450 system, such as gabapentin, topiramate and tiagabine. Unless the benefits outweigh the risks, valproic acid (sodium valproate) should be avoided as it has been shown to stimulate HIV replication. Since few data exist, controlled trials examining pharmacokinetic and pharmacodynamic interactions between anticonvulsants and antiretrovirals are needed. Until such time, clinicians caring for these patients should examine existing data carefully and employ vigilant monitoring.
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