Filgrastim Seems to Increase Survival in AIDS Patients but Mechanism Unclear -- HIV/AIDS INFO AND UPDATES

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Date Posted: 12:16:57 05/16/02 Thu
Author: Anonymous
Subject: Filgrastim Seems to Increase Survival in AIDS Patients but Mechanism Unclear

http://www.medscape.com/viewarticle/432340_print

Filgrastim Seems to Increase Survival in AIDS Patients but Mechanism Unclear

Reuters Health Information 2002. � 2002 Reuters Ltd
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Introduction
NEW YORK (Reuters Health) Apr 22 - Granulocyte colony-stimulating factor therapy in patients with AIDS-related cytomegalovirus (CMV) retinitis is associated with a 56% reduction in mortality, according to a recent report. However, the reason for this survival benefit does not appear to involve a reduction in bacterial infections.

Prior to the advent of highly active antiretroviral therapy (HAART), neutropenia was a relatively common finding in patients with AIDS, study author Dr. Douglas A. Jabs, from The Johns Hopkins University in Baltimore, and colleagues note in the March 29th issue of AIDS.

Because neutropenia is an established risk factor for bacterial infection, the authors hypothesized that treatment with filgrastim--granulocyte colony-stimulating factor, which reverses neutropenia--might prevent such infections and thereby improve survival.

To investigate, the researchers retrospectively studied 709 patients with AIDS-related CMV retinitis who were treated between 1990 and 1997. Of these patients, 398 had used filgrastim at some point.

Filgrastim use was associated with a significant reduction in the risks of catheter-related bacteremia and repeat bacterial infection (p = 0.02 and < 0.01, respectively), Dr. Jabs and colleagues found.

However, after adjustment for CD4+ T-cell count and antibiotic/antiretroviral therapy, filgrastim therapy was no longer linked to a significant reduction in these risks. The authors believe this may have been due to the confounding effect of trimethoprim-sulfamethoxazole use.

Despite no clear effect on bacterial infections, filgrastim use was tied to a 56% reduction in mortality (p < 0.001), the researchers state.

"Our observation of a large survival benefit with the use of filgrastim, while unexplained by a reversal of neutropenia or reduction of infection, deserves further exploration in a randomized controlled trial of this cytokine in non-neutropenic AIDS patients receiving HAART," Dr. Jab's team concludes.

AIDS 2002;16:757-765.

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