Use of protein A immunoadsorption as a treatment for thrombocytopenia in HIV-infected homosexual men: a retrospective evaluation of 37 cases.
Thirty-seven HIV-infected homosexual men with thrombocytopenia (less than 100 x 10(9)/l) received protein A immunoadsorption treatments to remove platelet-sensitizing immunoglobulin (Ig) G and circulating immune complexes (CIC) from plasma. Patients received an average of six treatments each, consisting of 250 ml plasma over a 3-week period. Clinical improvement in hemorrhagic symptoms associated with substantial increase in platelet counts was achieved in 18 patients. These responses were maintained over a median follow-up period of more than 7 months in 14 evaluable patients who were not lost to follow-up (three patients relapsed in 2 weeks and one received another therapy). Generally, moderate transient treatment-related side-effects included fever, musculoskeletal pain, chills and nausea. A transient serum sickness-like reaction was observed in seven patients, leading to termination of treatment in two. Clinical responses were associated with significant decreases in levels of platelet-sensitizing Ig, including CIC. Stimulation of broadly cross-reactive anti-antigen-binding fragment [F(ab)2], antibodies contributed to these responses. Protein A immunoadsorption is an effective alternative treatment for HIV-associated thrombocytopenia.
Snyder
H W
HW
IMRE Corporation, Seattle, Washington 98109-4933.
Bertram
J H
JH
Henry
D H
DH
Kiprov
D D
DD
Benny
W B
WB
Mittelman
A
A
Messerschmidt
G L
GL
Cochran
S K
SK
Perkins
W
W
Balint
J P
JP
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000276:immunology*; D001792:Blood Platelets / Q000276:immunology; D015658:HIV Infections / Q000150:complications*; D006716:Homosexuality; D006801:Humans; D007164:Immunosorbents / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D013205:Staphylococcal Protein A / Q000276:immunology*; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D001323:Autoantibodies; D007164:Immunosorbents; D013205:Staphylococcal Protein A