Drugs need not be stopped because of neutropenia in HIV-positive patients

Neutropenia in the presence of HIV infection is rarely severe and is not usually associated with additional infection, according to data from a prospective study carried out in London. Patients participating in the study continued drug therapy during the episodes of neutropenia, which resolved on mean average within 21 days.

Dr David A. J. Moore and colleagues at Chelsea and Westminster Hospital followed all adult HIV-positive patients at their clinic who developed absolute neutrophil counts of less than 1000 cells/mL. They report their findings in the February 1st issue of Clinical Infectious Diseases. From 17 000 inpatient and outpatient visits, 87 patients with new neutropenic episodes were identified. All but 3 patients were being treated with potentially myelosuppressive therapy, most with zidovudine, lamivudine and/or co-trimoxazole. For those with a first episode, the mean CD4+ cell count was 153/mL. The mean CD4+ cell count was lower, 103/mL, for subsequent episodes of neutropenia. First episodes averaged 25 days in duration, compared with 17 days for subsequent episodes. Only 3 patients presented with neutrophil counts less than 200 cells/mL. Only 4 serious and 8 more moderate infections developed during an episode of neutropenia. Two of the serious infections occurred in subjects with neutrophil count nadirs less than 200 cells/mL. Patients with infections had a lower mean CD4+ cell count than those without infections, 64/mL vs 126/mL.

“An observational strategy may be the optimal management in the absence of sepsis,” Dr Moore’s team concludes.