Uveitis Associated with Rifabutin Prophylaxis
Authors: Diane Havlir
Journal: Annals of Internal Medicine (1994)

Brief Communications1 October 1994Uveitis Associated with Rifabutin ProphylaxisDiane Havlir, MD, Francesca Torriani, MD, and Michael Dube, MDDiane Havlir, MDFrom the University of California San Diego, San Diego, California; the Los Angeles County Medical Center, University of Southern California, Los Angeles, California., Francesca Torriani, MDFrom the University of California San Diego, San Diego, California; the Los Angeles County Medical Center, University of Southern California, Los Angeles, California., and Michael Dube, MDFrom the University of California San Diego, San Diego, California; the Los Angeles County Medical Center, University of Southern California, Los Angeles, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-7-199410010-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The U.S. Public Health Task Force recommends rifabutin prophylaxis (300 mg daily) for the prevention of Mycobacterium avium complex infection in patients with human immunodeficiency virus (HIV) infection who have less than 100 CD4 cells/mm3[1, 2]. Rifabutin is reported to be well tolerated at daily doses of 300 mg or less [1, 3]; at doses greater than 1.5 g daily, rifabutin can cause uveitis and an arthralgia-arthritis syndrome [4]. Uveitis has also been observed in patients receiving lower doses (600 mg daily) of rifabutin for disseminated M. avium complex infection and in one patient receiving rifabutin (300 mg daily) as ...References1. Nightingale SD, Cameron DW, Gordin FM, Sullam PM, Cohn DL, Chaisson RE, et al. Two controlled trials of rifabutin prophylaxis against Mycobacterium avium complex infection in AIDS. N Engl J Med. 1993; 329(12):828-33. Google Scholar2. Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus. U.S. Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium avium complex. MMWR Morb Mortal Wkly Rep. 1993; 42(RR-9):14-20. Google Scholar3. O'Brien RJ, Lyle MA, Snider DE Jr. Rifabutin (ansamycin LM 427): a new rifamycin-S derivative for the treatment of mycobacterial diseases. Rev Infect Dis. 1987; 9:519-30. Google Scholar4. Siegal FP, Eilbott D, Burger H, Gehan K, Davidson B, Kaell AT, et al. Dose-limiting toxicity of rifabutin in AIDS-related complex: syndrome of arthralgia/arthritis. AIDS. 1990; 4:433-41. Google Scholar5. Shafran SD, Deschenes J, Miller M, Phillips P, Toma E. Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. MAC Study Group of the Canadian HIV Trials Network (Letter). N Engl J Med. 1994; 330:438-9. Google Scholar6. Frank MO, Graham MB, Wispelway B. Rifabutin and uveitis (Letter). N Engl J Med. 1994; 330:868. Google Scholar7. Fuller JD, Stanfield LE, Craven DE. Rifabutin prophylaxis and uveitis (Letter). N Engl J Med. 1994; 330:1315-6. Google Scholar8. Lewis RC, Hatfield NZ, Narang PK. A sensitive method for quantitation of rifabutin and its desacetyl metabolite in human biological fluids by high-performance liquid chromatography (HPLC). Pharm Res. 1991; 8(11):1434-40. Google Scholar9. Trapnell CB, Narang PK, Li R, Lewis R, Collborn D, Lavelle J. Fluconazole (FLU) increases rifabutin (RIF) absorption in HIV (+) patients on stable zidovudine (ZDV) therapy. In: Proceedings of the Ninth International Conference on AIDS, Berlin, Germany, June 6-11, 1993. London: Wellcome Foundation; 1993:504. Google Scholar10. Narang PK, Trapnell CB, Schoenfelder JR, Lavelle JP, Bianchine JR. Fluconazole and enhanced effect of rifabutin prophylaxis (Letter). N Engl J Med. 1994; 330(18):1316-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the University of California San Diego, San Diego, California; the Los Angeles County Medical Center, University of Southern California, Los Angeles, California.Corresponding Author: Diane Havlir, MD, University of California, San Diego, Treatment Center, 2760 Fifth Avenue, Suite 300, San Diego, CA 92103.Acknowledgments: The authors thank Dr. P.K. Narang for helping with the pharmacokinetics analysis; Drs. Kirsch, Peterson, and Kimberly, and Ms. Kathy Nuffer, for providing data on their patients; Drs. J. Allen McCutchan and R. Haubrich for giving their thoughtful comments on this manuscript; and Ms. Abbe Cavender for providing technical assistance.Grant Support: In part by the California Universitywide AIDS Research Program through the California Collaborative Treatment Group. Dr. Torriani is supported by the Swiss National Foundation for AIDS Research. The rifabutin serum levels were paid for by Pharmacia-Adria, Dublin, Ohio. 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