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Randomized controlled trial of short‐term withdrawal of i.v. immunoglobulin therapy for selected children with human immunodeficiency virus infection
Author(s) -
GRISARUSOEN GALIA,
LAU WENDY,
ARNESON CHERYL,
LOUCH DEBORAH,
BITNUN ARI,
STEPHENS DEREK,
READ STANLEY E.,
KING SUSAN M.
Publication year - 2007
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/j.1442-200x.2007.02492.x
Subject(s) - medicine , placebo , confidence interval , randomized controlled trial , antibody , viral load , antiretroviral therapy , human immunodeficiency virus (hiv) , gastroenterology , pediatrics , immunology , pathology , alternative medicine
Background: The aim of the present paper was to determine whether monthly i.v. immunoglobulin (IVIG) could be safely discontinued in antiretroviral‐treated human immunodeficiency virus (HIV)‐infected children. Methods: In a double‐blind cross‐over trial, children ≤18 years with HIV infection, well controlled on antiretroviral therapy, were randomized to alternating courses of 3 consecutive months of IVIG (400 mg/kg once a month) and 3 consecutive months of placebo for 1 year. The primary outcome was days of fever per month. Secondary outcomes were frequency of serious infections, changes in HIV viral load (VL), CD4+ counts and IgG levels. Results: Fifteen children were enrolled. Using the revised pediatric HIV clinical classification system of the Centers for Disease Control and Prevention, eight were severely symptomatic (C), four were moderately symptomatic (B) and three were mildly symptomatic (A). There were no statistically significant outcome measures. The mean number of days of fever per month with IVIG versus placebo was 0.55 days versus 1.48 days ( P = 0.11). The difference was 0.9 days (95% confidence interval: +2.05 to −0.25). There were no serious infections in either period. For the IVIG versus placebo periods, mean CD4 counts were 970 cells/μL versus 906 cells/μL ( P = 0.12), VL 2.90 log 10 copies/mL versus 2.82 log 10 copies/mL ( P = 0.70) and IgG levels were 17.41 g/L versus 16.6 g/L ( P = 0.13). Conclusion: In antiretroviral‐treated HIV‐infected children short‐term withdrawal of monthly IVIG was not associated with a significant increase in incidence of infections or a decline in immunologic function (CD4 count, viral load and IgG levels). These results suggest that monthly IVIG can be safely discontinued in HIV‐infected children who are clinically stable and receiving combination antiretroviral therapy.