Bulletin of Experimental Treatments for AIDS, No. 3, June 1989
Ron Baker

** Humphrey JG, et al. Plasmapheresis and acute Guillain Barr syndrome. Neurology , 35:1096 1104, August, 1985.

Plasmapheresis is not effective in treating HIV infected individuals with DSPN.

In plasmapheresis, blood is circulated outside the individual, antibodies to the nerve tissue and plasma are removed, and the blood cells are then returned to the patient along with a replacement fluid.

Dr. Dobri Kiprov and colleagues at Children's Hospital in San Francisco studied 30 gay men with polyneuropathy*.

** Kiprov D, et al. pp.3

Twenty one of the men had ARC and nine had AIDS. All had reduced T helper cell counts and all had antibodies to peripheral nerve tissue. Fifteen of these men with CIDP were treated with plasmapheresis because of severe progressive weakness and numbness.

The removal of antibodies to peripheral nerve tissue produced clinical improvement in 12 of 15 individuals.

** Kiprov D, et al, p. 3.

These men mainly had demyelinating* neuropathy (an axonal* neuropathy) did not respond to treatment. Three of the 4 individu- als who responded well to plasmapheresis later had relapses of peripheral neuropathy. When plasmapheresis was performed again, these individuals again showed significant clinical improvement. The researchers conclude that plasmapheresis is an effective treatment for most people with related CIDP.

In one study, 6 HIV infected individuals with CIDP and 3 with Guillain Barr syndrome recovered either spontaneously or after treatment with corticosteroids* or plasmapheresis

** Cornblath DR, et al. Inflammatory demyelinating peripheral neuropathy associated with HTLV III infection. Annals of Neurology , 21:32 40, 1987.

Because corticosteroid therapy is immunosuppressive, it may be hazardous to use in treating HIV infected individuals.

Plasmapheresis produces only mild side effects, which may include temporary lowering of blood pressure and a disturbed heart rhythm. Researchers suggest using the procedure to treat related CIDP when the clinical symptoms (weakness and numbness) start to interfere with normal functioning.

Each plasmapheresis treatment costs approximately $1,000 and most individuals with CIDP require an average of 10 treatments. Many insurance carriers now cover the cost of plasmapheresis for HIV related CIDP.

Physicians interested in finding out more about the procedure can contact Dr. Dobri Kiprov (Plasmapheresis Unit) or Dr. Robert Miller (Department of Neurology) at Children's Hospital in San Francisco (415 8700).

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