title: Use of protein A immunoadsorption as a treatment for thrombocytopenia in HIV-infected homosexual men: a retrospective evaluation of 37 cases.
abstract: 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.
authors.affiliation: IMRE Corporation, Seattle, Washington 98109-4933.
authors.forename: H W
authors.initials: HW
authors.lastname: Snyder
authors.forename: J H
authors.initials: JH
authors.lastname: Bertram
authors.forename: D H
authors.initials: DH
authors.lastname: Henry
authors.forename: D D
authors.initials: DD
authors.lastname: Kiprov
authors.forename: W B
authors.initials: WB
authors.lastname: Benny
authors.forename: A
authors.initials: A
authors.lastname: Mittelman
authors.forename: G L
authors.initials: GL
authors.lastname: Messerschmidt
authors.forename: S K
authors.initials: SK
authors.lastname: Cochran
authors.forename: W
authors.initials: W
authors.lastname: Perkins
authors.forename: J P
authors.initials: JP
authors.lastname: Balint
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D007164:Immunosorbents; D013205:Staphylococcal Protein A