TreatmentUpdate80 - Vol. 8, No. 0; August 1997
Sean Hosein

Infection with certain intestinal parasites can cause life-threatening diarrhea and weight loss in people with AIDS. Although treatment with the drugs albendazole and Flagyl« can help the immune system get rid of several parasites, these drugs do not help eliminate another parasite -- E. bieneusi. Doctors in England recently tested the drug thalidomide for this infection and have reported some success.

Study details

Researchers recruited 18 male subjects with AIDS who had diarrhea due to E. bieneusi for an average of 12 months (5 bowel movements daily). Many were using codeine, Lomotil or morphine to help reduce the diarrhea. All subjects had been unsucessfully treated with albendazole for 1 month before entering this study. The average CD4+ cell count was 27 cells. Doctors gave subjects thalidomide 100 mg/night for 1 month.

Results

Ten of 18 subjects experienced improvement in their symptoms after using thalidomide;

* 7 no longer had diarrhea

* 3 had a decrease in their symptoms

The remaining 8 subjects did not experience any improvement while in the study. One subject left the study after 6 days because his diarrhea became worse. He was eventually diagnosed with CMV infection of the intestine. Apart from this subject, all others still had detectable parasites in their stool samples after the study.

Why thalidomide worked?

The research team is not certain why thalidomide helped some subjects. The drug certainly damaged the parasites and likely stopped them from causing further infection. Thalidomide's anti-inflammatory action may also have helped the intestine recover from the damage caused by E. bieneusi. Although thalidomide can cause constipation, at 100 mg/night, the doctors didn't think this property was the source of its benefit. The study team did not provide any details about the long term monitoring of subjects so it is not clear how long the benefit of thalidomide lasted. For confirmed cases of diarrhea caused by E. bieneusi, short-term therapy with thalidomide may provide relief.

REFERENCES:

1. Sharpstone D, Rowbottom A, Francis N, et al. Thalidomide: a novel therapy for microsporidiosis. Gastroenterology 1997;112:1823-1829.

970801
CATE8004

Copyright © 1997 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca