Passive immunotherapy in advanced HIV infection and therapeutic plasmapheresis in asymptomatic HIV-positive individuals: a four-year clinical experience

Abstract

We have been treating patients with advanced HIV disease using passiveimmunotherapy (PIT). Earlier studies of PIT which have been publishedconcerned relatively short periods of treatment: our study is by far the longest and reports also on the long-term effects of plasmapheresis onhealthy HIV-infected individuals. Fifty-nine patients with an average CD4+T-cell count of 55 per cu.mm. at baseline were transfused at monthlyintervals with 500 ml of hyperimmune plasma. No disease progression ordeath occurred among the 8 asymptomatic patients under the treatment, whichlasted for 36.25 months on average. Seven of the 15 ARC patients progressedto AIDS but none died in an average period of 25.9 months. Seven of the 36symptomatic AIDS patients with advanced disease died in an average period of19.6 months. PIT appears to be nontoxic and to have beneficial effectslasting at least four years under continuous treatment. It probably delaysdisease progression in ARC and AIDS patients, and almost certainly does soin asymptomatic late HIV infection with a very low CD4+ T-cell count. Noneof the 51 donors suffered adverse effects, nor did any progress to ARC orAIDS in an average period of 30.1 months. Their laboratory parametersindicated a nearly stable condition: in particular, their average CD4+T-cell count rose from 478 to 498. The study of our plasma donors indicatedthat repeated and frequent plasma donation by asymptomatic HIV-infectedindividuals could delay disease progression, although further studies areneeded to investigate this.