TreatmentUpdate 72, Vol. 8, No. 8; October 1996
Sean Hosein

Infection with the parasite C. parvum can cause life-threatening diarrhea in PHAs. Doctors have tried many drugs to treat people infected with this parasite, including azithromycin, garlic enemas, paramomycin (Humatin) but use of these drugs do not work in every PHA. There have been a number of reports about the drug nitazoxanide but the details have not been published (see TreatmentUpdate 70). As well, none of these drugs deal with the underlying problem -- a weakened immune system.

GM-CSF

The chemical GM-CSF (granulocyte macrophage-colony-stimulating factor, also called Leukine(R)or Prokine(R)) is produced by the body and can stimulate the bone marrow to produce more white blood cells. It is used to treat people who have low levels of white blood cells because of chemotherapy, AZT or ganciclovir. It is possible that this bone marrow stimulant may also enhance the infection-fighting abilities of white blood cells.

Study details

Doctors in Milan have tested different drugs to try and help 2 PHAs with less than 50 CD4+ cells recover from diarrhea caused by C. parvum. The two had been treated with Humatin 4.3 grams/day for "at least 10 days" but their diarrhea did not resolve. The doctors then gave them GM-CSF -- 300 micrograms/day injected under the skin, for 14 days. They continued to receive paramomycin and AZT 500 mg/day.

Results

Recovery from diarrhea occurred in two days after the PHAs received GM-CSF. When the doctors stopped giving them GM-CSF the diarrhea returned and required several courses of GM-CSF (each course consisted of GM-CSF 300 mcg/day for 14 days). In one subject diarrhea disappeared and he has not had to use GM-CSF and Humatin for 6 months. The other subject's diarrhea decreased but never cleared. His condition gradually grew worse and he died 9 months after he began to use GM-CSF. Although these are only 2 cases, there is no effective treatment for the diarrhea caused by C. parvum and perhaps a pilot study with GM-CSF in other people with the same infection may confirm the drug's benefit or that of the related chemical G-CSF (granulocyte colony-stimulating factor).

REFERENCES:

1. Capetti A, Bonfanti P, Rizzardini G, et al . Can rHu-GM-CSF help in treating drug-resistant cryptosporidiosis in AIDS? Abstract G033.

2. Barsig J, Bundschuh DS, Hartung T, et al . Control of fecal peritoneal infection in mice by colony-stimulating factors. Journal of Infectious Diseases 1996;174(4):790-799.

3. Lejeune M, Sariban E, Cantinieux B, et al . Defective polymorphonuclear function in children receiving chemotherapy for cancer are partially restored by recombinant human granulocyte-colony stimulating factor in vitro. Journal of Infectious Diseases 1996;174(4):800-805.

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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