Document Detail


Granulocyte colony-stimulating factor use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients.
MedLine Citation:
PMID:  9528719     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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/mm3 versus 40 cells/ mm3, 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 decreased 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.
Authors:
P Keiser; S Rademacher; J W Smith; D Skiest; V Vadde
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  104     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-04-08     Completed Date:  1998-04-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  48-55     Citation Subset:  AIM; IM; X    
Affiliation:
University of Texas Southwestern Medical Center, The Department of Veterans Affairs Medical Center, Dallas 75216, USA.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / complications*
Bacteremia / prevention & control
Bacterial Infections / complications,  microbiology,  prevention & control*
Granulocyte Colony-Stimulating Factor / therapeutic use*
Humans
Neutropenia / drug therapy*,  microbiology
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
143011-72-7/Granulocyte Colony-Stimulating Factor

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