Superior effect of intravenous anti-D compared with IV gammaglobulin in the treatment of HIV-thrombocytopenia: results of a small, randomized prospective comparison.
This small, prospective, randomized study compared increases in platelet counts and duration of response after intravenous gammaglobulin (IVIG) and IV anti-D in patients with HIV-related thrombocytopenia (HIV-TP). Nine Rh+, nonsplenectomized HIV-positive patients with thrombocytopenia were treated sequentially, in random order, with IVIG and IV anti-D in a cross over design, receiving each therapy for 3 months. Peak platelet counts and duration of effect after each treatment were compared. In addition, viral load measurements and CD4 counts were followed serially, as well as thrombopoietin levels. IV anti-D resulted in a mean peak platelet count of 77 x 10(9)/L compared to only 29 x 10(9)/L after IVIG (P = 0.07). The mean duration of response was significantly longer in patients treated with anti-D (41 days) compared to IVIG (19 days, P = 0.01). No consistent changes were seen in the CD4 counts or viral load measurements as a result of either therapy. Thrombopoietin levels were normal in all patients despite often severe thrombocytopenia. Anti-D was more efficacious than IVIG for the treatment of HIV-TP, confirming and extending previous results. Anti-D should be the first line therapy in HIV-positive, Rh+ patients, when antiretroviral agents are not indicated, not effective, or there is an urgent need to increase the platelet count.
Scaradavou
Andromachi
A
New York Blood Center, New York, New York, USA.
Cunningham-Rundles
Susanna
S
Ho
John L
JL
Folman
Claudia
C
Doo
Howard
H
Bussel
James B
JB
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007518:Isoantibodies / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008533:Megakaryocytes / Q000821:virology; D008875:Middle Aged; D010865:Pilot Projects; D010976:Platelet Count; D011446:Prospective Studies; D018029:Rho(D) Immune Globulin; D016176:T-Lymphocyte Subsets; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D013926:Thrombopoietin / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin; D013926:Thrombopoietin