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Combined treatment with azidothymidine (AZT) and erythropoietin in children with HIV-infection.
Mueller BU; Jacobsen F; Jarosinki P; Lewis LL; Pizzo PA; Pediatric
December 30, 1995
Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:131.

Bone marrow suppression is the major dose-limiting toxicity in children with HIV infection. We evaluated the effect of subcutaneously or intravenously administered erythropoietin in pediatric patients who developed anemia (hgb less than 8 gm/dl) or transfusion dependency while on AZT, in spite of dosage reductions to 120 mg/m2 q 6h, in order to determine whether tolerance of AZT could be improved. Between 4/90 to 2/93 twelve patients between 8 months and 17.4 years old, all CDC class P2, were enrolled, 8 of whom were evaluable. 6 had acquired HIV infection vertically, 2 through transfusion. All had benefitted from AZT but had to stop secondary to bone marrow suppression. Endogenous erythropoietin levels were less than 200 IU in all patients. We used a sliding dosing schedule of erythropoietin in order to maintain the hemoglobin between 11-13 gm/dl. Patients were on study for a mean of 31.5 weeks (range 14-85); 6 patients died of progressive HIV disease, and 2 were switched to other antiretroviral regimens. Erythropoietin was very well tolerated in all children. No patient developed arterial hypertension, none of the deaths was related to erythropoietin, but one patient developed a rash that was questionably related to erythropoietin. With doses of erythropoietin ranging between 150 to 400 U/kg subcutaneously or intravenously every Monday, Wednesday, and Friday, all patients were able to tolerate and be maintained on doses of AZT between 120-180 mg/m2 q 6 hours. Transfusion requirement for packed red blood cells diminished markedly in 4 patients, and moderately in 2 patients. Erythropoietin appears to be beneficial in a selected group of HIV positive children with AZT-related bone marrow suppression and enables patients to continue receiving therapeutic doses of AZT.

Acquired Immunodeficiency Syndrome/*PHYSIOPATHOLOGY CD4 Lymphocyte Count Disease-Free Survival Human Risk Factors Survival Analysis Time Factors Zidovudine/THERAPEUTIC USE ABSTRACT