{"id":6513,"date":"2002-06-11T13:58:54","date_gmt":"2002-06-11T12:58:54","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=6513"},"modified":"2014-06-05T11:37:09","modified_gmt":"2014-06-05T11:37:09","slug":"filgrastim-seems-to-increase-survival-in-aids-patients-but-the-mechanism-remains-unclear","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/6513","title":{"rendered":"Filgrastim seems to increase survival in AIDS patients but the mechanism remains unclear"},"content":{"rendered":"

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.<\/strong><\/p>\n

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<\/p>\n

Because neutropenia is an established risk factor for bacterial infection, the authors hypothesised that treatment with filgrastim \u2014 granulocyte colony-stimulating factor, which reverses neutropenia \u2014 might prevent such infections and thereby improve survival.<\/p>\n

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.<\/p>\n

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.<\/p>\n

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.<\/p>\n

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

\u201cOur 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 randomised controlled trial of this cytokine in non-neutropenic AIDS patients receiving HAART,\u201d Dr Jab\u2019s team concludes.<\/p>\n

Comment<\/h3>\n

Similar benefits in advanced disease have also been reported for the immunotherapy agents GM-CSF (molgramostim) and gamma interferon.<\/strong><\/p>\n

Upregulation of phagocytic responses to pathogens may be one mechanism of action as well as improved antigen presentation and perhaps increased IL-2 receptor expression.<\/strong><\/p>\n

Reference:<\/p>\n

Davidson M, Min YI, Holbrook JT et al. Use of filgrastim as adjuvant therapy in patients with AIDS-related cytomegalovirus retinitis. AIDS 2002 Mar 29;16(5):757-65
\nhttp:\/\/www.ncbi.nlm.nih.gov:80\/entrez\/query.fcgi?cmd= Retrieve&db=PubMed&list_uids=11964532&dopt=Abstract<\/a>.<\/p>\n

Source: Reuters Health<\/p>\n","protected":false},"excerpt":{"rendered":"

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 …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31],"tags":[],"class_list":["post-6513","post","type-post","status-publish","format-standard","hentry","category-opportunistic-infections-coinfections-and-complications"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/6513","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=6513"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/6513\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=6513"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=6513"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=6513"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}