GM-CSF beneficial for patients with advanced HIV disease

In a phase III multicentre trial of patients with advanced HIV disease, granulocyte-macrophage colony-stimulating factor (GM-CSF) significantly increased CD4 T-cell and neutrophil counts, delayed the time to first infection, and reduced the incidence of overall infection.

Dr Jonathan B. Angel, of the University of Ottawa, Ontario, Canada, and colleagues from the Leukine/HIV Study Group randomised 309 patients to receive either placebo or GM-CSF for 24 weeks. The patients’ CD4 cell counts were between 50-100 cells/mm3, they had previously had an AIDS-defining illness, and they were on stable antiretroviral therapy.

Adjuvant GM-CSF significantly increased CD4 and neutrophil counts after 1, 3, and 6 months of therapy, as reported in the March 10th issue of AIDS. Sixty-seven percent of patients receiving GM-CSF developed an infection, compared with 78% of patients receiving placebo. In addition, GM-CSF delayed the time to first infection to 97 days, compared with 56 days for placebo

The study showed that there were no differences between groups in cumulative opportunistic infections or changes in HIV RNA.

The authors suggest that the addition of GM-CSF to an effective regimen of antiretroviral therapy could delay virologic failure. ‘Whether the ability of GM-CSF to maintain viral suppression as observed in the advanced HIV population will translate to individuals with earlier stages of HIV disease remains to be evaluated.’