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Chronic pure red cell aplasia caused by parvovirus B19 in AIDS: Use of intravenous immunoglobulin—A report of eight patients
Author(s) -
Koduri Prasad Rao,
Kumapley Rudolf,
Valladares Jose,
Teter Caroline
Publication year - 1999
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199905)61:1<16::aid-ajh4>3.0.co;2-y
Subject(s) - medicine , parvovirus , pure red cell aplasia , aplasia , gastroenterology , antibody , intravenous immunoglobulin therapy , bone marrow , surgery , parvoviridae , immunology , virus
The optimal management of chronic pure red cell aplasia caused by parvovirus B19 (B19‐PRCA) in patients with AIDS is unclear. Our purpose was to determine the effects of intravenous immunoglobulin (IVIg) in the treatment of B19‐PRCA in patients with AIDS. The patients were eight adults with AIDS admitted during the period 1993–1997. A diagnosis of B19‐PRCA was made if all the following criteria were met: 1. Bone marrow biopsy finding of pure red cell aplasia; 2. Detection of parvovirus B19 DNA in serum; and 3. No alternative explanation for PRCA. Initial (induction) therapy was with IVIg 1 g/kg daily for 1–2 days. Relapses were treated with IVIg 1 g/kg for 2 days. Maintenance therapy with IVIg 0.4–1.0 g/kg q 4 weeks was given to those patients who developed a second or subsequent relapse. The patients were followed for a mean of 27 months (range 8–38 months). All patients responded to initial therapy with IVIg. Six patients with CD4 counts <80 cells/mm 3 relapsed. The response was short lived in two patients with a CD4 count <80 cells/mm 3 who were given a single infusion of IVIg 1 g/kg as initial therapy. Four patients were given regular maintenance IVIg therapy following a second or subsequent relapse and remain in remission. Two patients whose CD4 counts were >300 cells/mm 3 remain in continuous unmaintained remission from B19‐PRCA for over 8 and 11 months, respectively, following induction therapy with IVIg. AIDS patients with B19‐PRCA respond well to therapy with IVIg 2 g/kg given over 2 days. Most patients with CD4 counts of ≤80 cells/mm 3 suffer relapse within six months necessitating retreatment with IVIg; maintenance therapy with IVIg 0.4 g/kg q 4 weeks is effective in preventing relapse of B19‐PRCA, and may be cost effective. Routine maintenance therapy is probably not indicated in patients with CD4 counts over 300 cells/mm 3 . Prospective studies are needed to confirm these findings. Am. J. Hematol. 61:16–20, 1999. © 1999 Wiley‐Liss, Inc.