Use of filgrastim as adjuvant therapy in patients with AIDS-related cytomegalovirus retinitis

Michael Davidson, Yuan I. Min, Janet T. Holbrook, Mark L. Van Natta, Robert Murphy, Douglas A. Jabs, William Welch, Curtis L. Meinert

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Neutropenia in AIDS predisposes to bacterial infection. Granulocyte colony-stimulating factor (filgrastim) can reverse neutropenia. Objective: To determine the effects of filgrastim on bacterial infections, hospitalization, and mortality in patients with cytomegalovirus retinitis and AIDS. Methods: Using a person-time analysis, a retrospective cohort study of filgrastim adjuvant therapy in three multicenter clinical trials of anti-cytomegalovirus therapy during the period 1990-1997 measured filgrastim use, bacterial infections, and mortality. Results: Of 719 patients, 379 patients used filgrastim for 31% of the follow-up time. There was an inverse relationship between the 389 confirmed bacterial infections, including 186 bacteremias, and absolute neutrophil counts. Before adjustment for CD4 T-cells counts and antibiotic/antiretroviral therapy, filgrastim was associated with reduced risk of catheter-related bacteremia [relative risk (RR), 0.52; P = 0.02] and repeat bacterial infection (RR, 0.41; P = < 0.01). After adjustment, the RR of catheter-related bacteremia with filgrastim use was decreased (RRadj, 0.69; P = 0.16) and the RR of repeat bacterial infection with filgrastim use was of marginal significance (RRadj, 0.57; P = 0.07), possibly due to the confounding effect of trimethoprim-sulfamethoxazole on all bacteremia (RRadj, 0.55; P= < 0.01). Unrelated to bacteremia, filgrastim use was associated with a 56% reduction in mortality (P < 0.01). Conclusions: There was a large survival benefit associated with filgrastim use in this study but the reasons for this benefit are unclear. Although a reduction in crude risk of some bacterial infections with filgrastim use was detected, after adjustment for potentially confounding factors these risks were smaller and no longer statistically significant.

Original languageEnglish (US)
Pages (from-to)757-765
Number of pages9
JournalAIDS
Volume16
Issue number5
DOIs
StatePublished - Mar 29 2002

Keywords

  • AIDS
  • Cytomegalovirus retinitis
  • Filgrastim
  • Granulocyte-macrophage colony-stimulating factor
  • Neutrophil count

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Use of filgrastim as adjuvant therapy in patients with AIDS-related cytomegalovirus retinitis'. Together they form a unique fingerprint.

Cite this