Marked disparity in incidence of bacterial infections in patients with the acquired immunodeficiency syndrome receiving interleukin-2 or interferon-gamma.
OBJECTIVE
To compare the infectious complications that occurred during trials of immunomodulatory agents in patients with the acquired immunodeficiency syndrome (AIDS).


METHODS
A survey of two cohorts of patients with AIDS who participated in nonrandomized, unblinded, non-placebo-controlled investigations of the toxicity and efficacy of interleukin-2 and interferon-gamma.


METHODS
Clinical research unit in a tertiary care center.


METHODS
Consecutive samples of 52 patients given interleukin-2 and 22 patients given interferon-gamma. Selection criteria for referred patients included a diagnosis of AIDS, hemoglobin level of greater than 100 g/L (2.0 mg/dL), creatinine level of less than 176.8 mumol/L, bilirubin level of less than 25.65 mumol/L (1.5 mg/dL), the absence of active infection, and the absence of other drug therapy for 2 weeks before entry. Four patients given interleukin-2 failed to complete the study.


METHODS
Intravenous infusion of natural-product or recombinant human interleukin-2, 250 to 10,000,000 U/day for 23.4 +/- 1.5 (SE) days, or recombinant human interferon-gamma, 0.001 to 1.0 mg/m2.d for 17.7 +/- 4.8 days.


RESULTS
Twenty nonopportunistic bacterial infections occurred in 17 of 52 patients given interleukin-2, whereas non occurred in 22 patients given interferon-gamma (P less than 0.05). Bacteremia accounted for 12 of the infections. Staphylococcus aureus and gram-negative bacilli accounted for 16 of the isolates. Opportunistic infections occurred in 6 patients during interleukin-2 infusion and in 1 patient during interferon-gamma infusion (P greater than 0.5). Clinical and immunologic variables and methods of management of intravenous catheters were similar in the two groups.


CONCLUSIONS
A marked disparity in infection with nonopportunistic bacteria, but not with opportunistic organisms, occurred in patients with AIDS who were treated with interleukin-2 as compared with those who were treated with interferon-gamma. A high incidence of bacteremia and localized bacterial infection should be anticipated in patients with AIDS who receive interleukin-2.
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000628:therapy*; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects; D007371:Interferon-gamma / Q000627:therapeutic use*; D007376:Interleukin-2 / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology; D018805:Sepsis / Q000453:epidemiology
D007376:Interleukin-2; D007371:Interferon-gamma