AEGiS-GMHC: TREATMENT BRIEFS: Pentoxifylline: Disappointing Data and a Warning

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

TREATMENT BRIEFS: Pentoxifylline: Disappointing Data and a Warning

Gay Men's Health Crisis: Treatment Issues, Volume 8 no. 4 - June 1994
David Gold

Pentoxifylline (also called trental) is an approved treatment for a circulation disorder caused by a narrowing of the arteries. The drug is also being used by HIV-infected people based on preliminary data that suggests it reduces tumor necrosis factor (TNF), an immune system protein that may increase HIV replication and contribute to wasting syndrome. However, a three week study by researchers from the Veteran's Administration Medical Center in Palo Alto, California reported that pentoxifylline produced no immediate benefits in terms of CD4 counts, viral load or clinical status (May 1994; Journal of AIDS; 7:5(5)19-20). In addition, significant side effects were seen at the dose given (2,400mg per day). Of nine HIV-positive patients (CD4 count less than 400) given the drug, one patient had to be reduced to 1,200mg per day and three others could not tolerate the drug at either dose. Reported side effects included fevers, gastrointestinal upset, headaches, and nausea. No antiretroviral therapy (AZT, ddI or ddC) was given.

The six remaining patients were followed for three weeks of therapy. Viral load (as measured by HIV plasma RNA and p24 antigen) did not change in five of six patients. In addition, no overall effects on TNF levels were seen.

In a reply to the published results, Dr. Bruce Dezube, a researcher from Beth Israel Hospital in Boston who has done extensive studies of pentoxifylline, noted that antiretroviral therapy such as AZT was not included in the study regimen. Dr. Dezube believes that if pentoxifylline is to play a role in the overall treatment of HIV disease, it will be in combination with an antiretroviral agent. The VA study comes on the heels of a request by the BGA, Germany's drug regulatory agency, that doctors report any changes in the retina in patients treated with pentoxifylline. According to Scrip, a drug industry newsletter, the advisory was issued because a patient on pentoxifylline developed retina bleeding and detachment. The BGA emphasized that no causal relationship has been established between the drug and retinal disorders. Pentoxifylline is known to cause bleeding of the skin, mucosal areas and stomach.

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