IV immune globulin prevents infection in adults with HIV
Kiehl MG, Stoll R, Broder M, et al. A controlled trial of intravenous immune globulin for the prevention of serious infections in adults with advanced human immunodeficiency virus infection. Arch Intern Med 1996; 156:2545-1550.
Previous studies of high-dose immune globulin therapy to reduce recurrent infections have been performed in children with HIV, but this is the first study of the use of immune globulin in adults with HIV. These German investigators set out to determine the efficacy of intravenous (IV) immune globulin therapy in preventing infections and reducing days with fever, and in reducing the duration and frequency of hospitalization for HIV-infected adults.
The prospective, randomized outpatient clinical trial included 70 treated patients and 57 untreated patients. Two groups of patients received IV immune globulin in doses of either 400 mg/kg or 200 mg/kg, both initially and every 21 days after. Primary endpoints of the study were the occurrence of laboratory-proven or clinically diagnosed infections and death caused by infection.
Compared to patients in the control group, patients receiving IV immune globulin treatment had significantly more time free from serious infection (p < .001) compared to untreated patients. Twelve (17%) of treated patients had infection-related deaths compared to 20 (35%) of control patients. In addition, treated patients had an overall reduction in the number and duration of hospitalizations for short-term care, days with fever, and frequency of diarrhea. Because of those results, the study was discontinued by the local ethical board.
"Prophylactic IV immune globulin treatment in HIV-infected adults decreases the frequency of serious infections and is associated with a reduction of hospitalization for short-term care," the authors conclude.
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