Management of the hematologic complications of human immunodeficiency virus infection.

Replication of various strains of human immunodeficiency virus can be increased in vitro by certain colony-stimulating factors (CSFs), but the protective effect of zidovudine (AZT) on macrophages is not antagonized in the presence of those factors--specifically, in the presence of granulocyte-macrophage CSF (GM-CSF). In clinical studies, GM-CSF given alone dramatically increased counts of white cells, particularly neutrophils and band cells. Very small doses of GM-CSF, self-administered subcutaneously, restored white cell production in leukopenic patients with AIDS. Combination treatment with AZT and GM-CSF in AZT-intolerant patients allowed resumption of AZT treatment and increased bone marrow cellularity. Treatment of anemic patients who have AIDS or AIDS-related complex with recombinant human erythropoietin (r-HuEPO) produced promising results. After 12 weeks of treatment with r-HuEPO, the need for transfusions to maintain hematocrit values within the normal range was reduced significantly or eliminated in patients with low baseline levels of endogenous erythropoietin. Studies combining AIDS chemotherapy with CSF or erythropoietin treatment are proposed.