TreatmentUpdate 70, Volume 8, No 6; September, 1996
Sean Hosein

Less than normal levels of white blood cells can occur in some people with HIV/AIDS, particularly those who have certain infections -- CMV and MAC -- or use certain drugs including:

* AZT

* Bactrim/Septra

* chemotherapy

* ganciclovir

Reduced numbers of white blood cells make fighting infections even more difficult. Doctors at a clinic in Copenhagen, Denmark who have been conducting a study with the bone marrow stimulant G-CSF (granulocyte-colony-stimulating factor, filgrastim, Neupogenr) report interesting results. In their study, all subjects had less than 50 CD4+ (T4+) cells and low numbers of white blood cells - 1 billion or less (normal range: 4 to 11 billion). Many subjects had low numbers of a particular white blood cell call neutrophils - less than half a billion (normal range: 1.8 to 7 billion).

Sixty subjects received G-CSF daily until their white blood cell (WBCs) levels increased to 1.5 billion. Although the dose was not stated, a common protocol is to use 300 æg injected under the skin once daily for five consecutive days, followed by the same dose on Monday, Wednesday and Friday until the WBCs increase to an acceptable level. Once the 1.5 billion level was reached, the drug was given three times weekly. In the meantime, doctors observed a similar group of 104 subjects who had low levels of WBCs who were not given G-CSF.

Results

At least half the subjects who received G-CSF lived for 658 days. The equivalent figure for subjects not receiving G-CSF was 511 days. This difference was statistically significant; that is, not likely due to chance alone. These results may not be surprising in light of some research done in the US. Doctors there gave "76 [subjects] at different stages of [HIV infection]" filgrastim 300 micrograms injected under the skin "four times daily every other day for 8 days." Doctors conducting the study found that the WBCs ability to kill bacteria was increased to levels seen in non-HIV-infected people.

References:

1. Grutzmeier S, Gerstoft J, Boje HP, et al. Filgrastim (G-CSF) use is associated with prolonged survival in AIDS-patients with leukopenia and CD4+ cells < 50 x 106/L. We.A.3094.

960910
CATE7009

Copyright © 1996 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca