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Utilisation of colony stimulating factors (CSF) in an HIV treatment centre: CSF initiation modalities and impact on anti-infective agent use.


Int Conf AIDS. 1998;12:861 (abstract no. 42436). Unique Identifier :

BACKGROUND: Neutropenia in HIV infection has various etiologies, impact on morbidity is complex, rendering management difficult and poorly standardised. We have attempted to evaluate the use of CSFs in the setting of a university HIV treatment reference centre, in order to optimise and rationalise CSF prescription. DESIGN: Prospective evaluation of CSF dispensation. METHODS: A cohort of HIV infected patients (pts) cared for in the Rothschild University Hospital, Paris, and receiving G-CSF, Granulocyte Colony Stimulating Factor (Filgrastim) or GM-CSF, Granulocyte Macrophage-CSF (Molgramostim) between Jan. 94-Dec. 95 were identified and followed up to June 96. CSF was delivered in a compassionate use program or in an approved indication. Data was extracted from physicians' precriptions and a specific drug dispensation computer base in the hospital Pharmacy. Two variables were studied according to the etiology of neutropenia: time to CSF initiation and use of antinfective agents (AI). RESULTS: 124 patients were identified during the study period. Three groups were individualised according to the major etiology of neutropenia leading to CSF prescription: Ganciclovir (GCV)-induced (n = 67), chemotherapy-related (chemo) (n = 24), all other pts (n = 33). Mean time to CSF prescription was 120 +/- 38* days (d), 101 +/- 45* d, and 550 +/- 100** d, in each group respectively (* vs ** p < 10(-9). 71/124 pts (57%) received AI during the evaluation period. Four groups, all treated with zidovudine, were individualised in terms of etiology of neutropenia and AI received, as follows. Time to CSF prescripion was not significantly different in later subgroups. TABULAR DATA, SEE ABSTRACT VOLUME. CONCLUSION: Neutropenia in HIV infection should be optimally managed considering risk and cost issues. The close collaboration of physicians and pharmacists, who carefully monitor CSF and anti-infective dispensation, will help identify the the subgroup of patients in whom CSF use is clinically relevant.

MEETING ABSTRACTS Anti-HIV Agents/THERAPEUTIC USE Colony-Stimulating Factors/*THERAPEUTIC USE Filgrastim/THERAPEUTIC USE Granulocyte-Macrophage Colony-Stimulating Factor/THERAPEUTIC USE Human Neutropenia/*DRUG THERAPY Prospective Studies Recombinant Proteins/THERAPEUTIC USE Zidovudine/THERAPEUTIC USE


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.