Granulocyte colony-stimulating factor use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients

被引:27
作者
Keiser, P [1 ]
Rademacher, S [1 ]
Smith, JW [1 ]
Skiest, D [1 ]
Vadde, V [1 ]
机构
[1] Univ Texas, SW Med Ctr, Dept Vet Affairs Med Ctr, Div Infect Dis 111D, Dallas, TX 75216 USA
关键词
D O I
10.1016/S0002-9343(97)00269-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Neutropenia occurs in up to 17% of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival. METHODS: A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI). RESULTS: The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm(3) versus 40 cells/mm(3), P = 0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P = 0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P = 0.002). In a multivariate analysis, significant de creased risk for bacteremia was found with G-CSF use (odds ratio [OR] = 0.15, P = 0.02). Survival was longer in patients treated with G-CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP. CONCLUSIONS: We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients. (C) 1998 by Excerpta Medica, Inc.
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页码:48 / 55
页数:8
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