Extracorporeal Photopheresis in the Treatment of AIDS-Related Complex: A Pilot Study

Abstract

Objective: To determine side effects of extracorporeal photopheresis in the treatment of patients with the acquired immunodeficiency syndrome (AIDS)-related complex, and to gain early evidence of efficacy of the treatment. Design: Uncontrolled trial. Setting: Tertiary referral center. Patients: Five patients with AIDS-related complex: three homosexual men and one man and one woman with histories of intravenous drug abuse. One patient, a homosexual man, withdrew from therapy after 5 months but returned for monthly clinical and laboratory evaluations. Intervention: Monthly treatments with extracorporeal photopheresis. Measurements and main results: Symptoms resolved in four patients. Lymphadenopathy disappeared in all five. Four patients had delayed-hypersensitivity reactions to skin testing (as defined by the Walter Reed staging classification). All showed increases in p24 and gp120 antibody levels. The CD4-cell percentage increased in four patients and declined in one after 6 months of therapy, but the absolute CD4 count decreased in two patients. At 15 months, the CD4 percentage remained at or increased over the baseline value in three patients still in the study but decreased in one. Levels of Beta2-microglobulin decreased or remained stable in four patients. All patients were culture positive or the human immunodeficiency virus (HIV) before treatment. One patient had a negative viral culture ater 5 months of treatment with confirmation. Two other patients became HIV culture negative, one at 14 and one at 15 months: The former patient became positive at 15 months and the latter patient remained negative at 16 months. Conclusions: The preliminary results suggest that extracorporeal photopheresis deserves further evaluation as therapy for AIDS-related complex.