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Esophageal Ulcers in AIDS
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IN RESPONSE:
The letters by Couderc and associates and Domingo and colleagues reflect the growing clinical experience with thalidomide for the treatment of HIV-associated idiopathic (aphthous) oropharyngeal and esophageal ulcers. Because this agent is not widely available in the United States, published studies to date have been from investigators in Europe and Australia [1]. Our preliminary experience with this drug has been encouraging [2] and is similar to that described by Couderc and associates and by Domingo and colleagues. As with most disorders related to the acquired immunodeficiency syndrome, relapse is common; however, data are insufficient to suggest that the relapse rate is reduced after successful treatment with thalidomide compared with oral corticosteroids. The apparent efficacy, favorable side-effects profile, and reduced cost suggest that thalidomide may be an ideal drug for these disorders, particularly in men. This opinion will best be validated, however, in a prospective trial comparing thalidomide with corticosteroids. The devastating effects of thalidomide on the fetus are cause for caution, regardless of efficacy. Given that thalidomide has important immunoregulatory properties, long-term use may be related to the development of opportunistic infections, similar to those associated with corticosteroids [3]. Thus, long-term follow-up of patients receiving thalidomide daily is needed before it can be concluded that thalidomide is safer than corticosteroids. If these lesions are caused by or perpetuated through tumor necrosis factor [4], pentoxifylline may also be efficacious [5]. I look forward to prospective, comparative drug trials designed to determine the best short- and long-term treatments for these disorders.
C. Mel Wilcox, MD
University of Alabama at Birmingham
Birmingham, AL 35294
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
