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Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison
Author(s) -
Scaradavou Andromachi,
CunninghamRundles Susanna,
Ho John L.,
Folman Claudia,
Doo Howard,
Bussel James B.
Publication year - 2007
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/ajh.20813
Subject(s) - medicine , thrombopoietin , platelet , gastroenterology , viral load , gamma globulin , prospective cohort study , human immunodeficiency virus (hiv) , immunopathology , immunology , antibody , genetics , stem cell , haematopoiesis , biology
This small, prospective, randomized study compared increases in platelet counts and duration of response after intravenous gammaglobulin (IVIG) and IV anti‐D in patients with HIV‐related thrombocytopenia (HIV‐TP). Nine Rh+, nonsplenectomized HIV‐positive patients with thrombocytopenia were treated sequentially, in random order, with IVIG and IV anti‐D in a cross over design, receiving each therapy for 3 months. Peak platelet counts and duration of effect after each treatment were compared. In addition, viral load measurements and CD4 counts were followed serially, as well as thrombopoietin levels. IV anti‐D resulted in a mean peak platelet count of 77 x 10 9 /L compared to only 29 x 10 9 /L after IVIG ( P = 0.07). The mean duration of response was significantly longer in patients treated with anti‐D (41 days) compared to IVIG (19 days, P = 0.01). No consistent changes were seen in the CD4 counts or viral load measurements as a result of either therapy. Thrombopoietin levels were normal in all patients despite often severe thrombocytopenia. Anti‐D was more efficacious than IVIG for the treatment of HIV‐TP, confirming and extending previous results. Anti‐D should be the first line therapy in HIV‐positive, Rh+ patients, when antiretroviral agents are not indicated, not effective, or there is an urgent need to increase the platelet count. Am. J. Hematol. 82: 2007. © 2006 Wiley‐Liss, Inc.