[The effect of the type of factor VIII concentrate on the CD4 lymphocyte count in hemophiliacs with human immunodeficiency virus infection: the results of a meta-analysis].
BACKGROUND
The administration of factor VIII concentrates of intermediate purity in HIV+ hemophiliac patients has been related with disorders of the immunologic system of these patients which may be observed in a more acute decrease in CD4 lymphocyte count in relation to that described in patients treated with products of greater purity. The present study evaluates the impact of these treatments (concentrates of intermediate or high purity) on the immune system of HIV+ hemophiliac patients by exhaustive analysis of the literature.


METHODS
Meta-analysis of 8 clinical studies published between 1983 and 1993 was performed by multivariate analysis which considers the decrease in the number of CD4 lymphocytes as an indicator of the evolution of the disease. Likewise, the size of the effect and combined significance were also evaluated.


RESULTS
The absolute decrease in the number of CD4 lymphocytes is significantly lower in patients treated with products of greater purity (354 +/- 52 vs 448 +/- 54 cells/microliters p = 0.037) as was the size of the effect and the different tests of combined significance. The speed of decrease was between 1.25 and 16.55 cells/microliters/year lower in the treated group than in the control (p = 0.029).


CONCLUSIONS
According to meta-analysis, the factor VIII concentrates of intermediate purity influence the immune system of HIV+ hemophiliac patients to a greater extent leading to a more acute decrease in the number of CD4 lymphocytes over time. Further studies are required to confirm whether this facts leads to differences in clinical manifestations of the infection or in survival.
Montoro Ronsano
J B
JB
Unidad de Hemofilia, Hospital General Universitari Vall d'Hebron, Barcelona.
Oliveras Martín
J
J
Tusell Puigbert
J M
JM
D000293:Adolescent; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D002648:Child; D005169:Factor VIII / Q000302:isolation & purification / Q000627:therapeutic use*; D015658:HIV Infections / Q000276:immunology / Q000628:therapy*; D015497:HIV-1; D006467:Hemophilia A / Q000276:immunology / Q000628:therapy*; D006801:Humans
D005169:Factor VIII
Influencia del tipo de concentrado de factor VIII sobre la cifra de linfocitos CD4 en hemofílicos con infección por el virus de la inmunodeficiencia humana: resultado de un metaanálisis.