Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison

Abstract

This small, prospective, randomized study compared increases in platelet counts and duration of response after intravenous gammaglobulin (IVIG) and IV anti-D in patients with HIVrelated thrombocytopenia (HIV-TP). Nine Rh+, nonsplenectomized HIV-positive patients with thrombocytopenia were treated sequentially, in random order, with IVIG and IV anti-D in a cross over design, receiving each therapy for 3 months. Peak platelet counts and duration of effect after each treatment were compared. In addition, viral load measurements and CD4 counts were followed serially, as well as thrombopoietin levels. IV anti-D resulted in a mean peak platelet count of 77 x 10 9 /L compared to only 29 x 10 9 /L after IVIG (P = 0.07). The mean duration of response was significantly longer in patients treated with anti-D (41 days) compared to IVIG (19 days, P ¼ 0.01). No consistent changes were seen in the CD4 counts or viral load measurements as a result of either therapy. Thrombopoietin levels were normal in all patients despite often severe thrombocytopenia. Anti-D was more efficacious than IVIG for the treatment of HIV-TP, confirming and extending previous results. Anti-D should be the first line therapy in HIV-positive, Rh+ patients, when antiretroviral agents are not indicated, not effective, or there is an urgent need to increase the platelet count. Am. J. Hematol. 82:335-341, 2007. V V C 2006 Wiley-Liss, Inc.

Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era

“…This is consistent with findings from the study by Landonio, in which only four of 17 patients treated with IVIG had sustained remissions, and all patients treated with steroids had recurrent ITP after discontinuation of initial therapy [8]. In a randomized cross-over study of nine patients with severe HIV-associated ITP, Scaradavou found the median duration of response was 19 days following treatment with IVIG and 41 days following anti-RhD [17]. …”

Intravenous Immunoglobulin and Anti-RhD Therapy in the Management of Immune Thrombocytopenia

“…No changes in CD4 counts or viral loads were reported. 25 Although there was a small number of patients in this study, this confirms previous results. 20,26 …”

Investigation of whether the acute hemolysis associated with Rho(D) immune globulin intravenous (human) administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model

“…Most patients treated with WinRho for ITP or secondary thrombocytopenia do not experience signs/symptoms of acute hemolysis, 1,3‐13 and not all who experience signs/symptoms of acute hemolysis experience hemolysis‐related complications 14 or require medical intervention for any complications experienced 13‐16 . Nonetheless, the acute hemolysis–associated complications that have been reported to date include clinically significant anemia, the need for RBC transfusion(s), acute or exacerbated renal failure, the need for dialysis, disseminated intravascular coagulation, and death secondary to these complications 14,17 .…”