Immunomodulatory treatment of Mycobacterium avium complex bacteremia in patients with AIDS by use of recombinant granulocyte-macrophage colony-stimulating factor.
Eight AIDS patients with Mycobacterium avium complex (MAC) bacteremia were randomized to receive azithromycin with or without granulocyte-macrophage colony-stimulating factor (GM-CSF) for 6 weeks to examine the effect of GM-CSF administration on clearance of mycobacteremia and on monocyte function. Superoxide anion production was significantly increased ex vivo in monocytes from patients receiving GM-CSF but not in those from patients receiving azithromycin alone. Relative to monocytes obtained from untreated healthy controls, median differences in viable intracellular MAC at 2, 4, and 6 weeks were -0.76, -0.94, and -0.47 log10 cfu/mL of lysate for cells from patients receiving GM-CSF versus -0.15, -0.11, and -0.19 log10 cfu/mL for cells from patients receiving azithromycin alone. Although no effect on mycobacteremia was detected, the administration of GM-CSF to AIDS patients with MAC bacteremia resulted in activation of their blood monocytes, as evidenced by increased superoxide anion production and enhanced mycobactericidal activity. GM-CSF deserves further investigation in the treatment of mycobacterial infections.
Kemper
C A
CA
Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA.
Bermudez
L E
LE
Deresinski
S C
SC
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000628:therapy*; D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009000:Monocytes / Q000276:immunology / Q000378:metabolism / Q000502:physiology; D015269:Mycobacterium avium Complex / Q000187:drug effects; D015270:Mycobacterium avium-intracellulare Infection / Q000097:blood / Q000628:therapy*; D013481:Superoxides / Q000032:analysis / Q000378:metabolism
D000276:Adjuvants, Immunologic; D000900:Anti-Bacterial Agents; D013481:Superoxides; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D017963:Azithromycin