van der Ven A J, Koopmans P P, Vree T B, van der Meer J W
Department of Internal Medicine, University Hospital St Radboud Nijmegen, The Netherlands.
Lancet. 1991 Aug 17;338(8764):431-3. doi: 10.1016/0140-6736(91)91046-w.
The origin of the increased frequency of side-effects to co-trimoxazole in HIV-positive patients is unknown. Data on plasma concentrations of the parent compounds are inconclusive. Evidence points to the hydroxylamine derivatives of sulphamethoxazole as the reactive metabolites that cause adverse reactions to co-trimoxazole. HIV-positive individuals have a systemic glutathione deficiency, and therefore a reduced capacity to scavenge such metabolites. This process would lead to an increased exposure to toxic intermediates and would explain the high frequency of adverse reactions to co-trimoxazole in these patients.
HIV 阳性患者中复方新诺明副作用频率增加的原因尚不清楚。关于母体化合物血浆浓度的数据尚无定论。有证据表明，磺胺甲恶唑的羟胺衍生物是导致复方新诺明不良反应的活性代谢产物。HIV 阳性个体存在全身性谷胱甘肽缺乏，因此清除此类代谢产物的能力降低。这一过程将导致机体更多地暴露于有毒中间体，从而解释了这些患者中复方新诺明不良反应的高发生率。
