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Interferon-Alpha Is Effective in the Treatment of HIV-1–Related, Severe, Zidovudine-Resistant Thrombocytopenia: A Prospective, Placebo-controlled, Double-Blind Trial

Massimo Marroni, MD; Paolo Gresele, MD, PhD; Giuseppe Landonio, MD; Adriano Lazzarin, MD; Massimo Coen, MD; Roberta Vezza, PharmD; Marina Silva Sinnone, MD; Enrico Boschetti, MD; Anna Maria Nosari, MD; Giuliano Stagni, MD; Giuseppe Giorgio Nenci, MD; and Sergio Pauluzzi, MD
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From the University of Perugia, Perugia; Niguarda Hospital, Milan; San Raffaele University Hospital, Milan; Sacco Hospital, Milan, Italy. Requests for Reprints: Paolo Gresele, MD, PhD, Institute of Internal and Vascular Medicine, University of Perugia, via E. dal Pozzo, I-06126 Perugia, Italy. Acknowledgments: The authors thank Ms. Catia Alessandri for secretarial assistance; the following nurses for their assistance with drug treatment: Ms. Salvatrice Ferrini, Mr. Ennio Giommetti, Ms. Rossella Giorgetti, Ms. Manuela Simioni, Ms. Isa Strazio, and Ms. Francesca Visconti; and Daniela Cattaneo, MD, and Giuseppe V.L. De Socio, MD, who helped with patient management. Grant Support: Wellcome, Italia, provided the study drug (interferon-α).

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(6):423-429. doi:10.7326/0003-4819-121-6-199409150-00005
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Objective: To determine the effect of interferon-α for severe, zidovudine-resistant, HIV-1–related thrombocytopenia.

Design: Prospective, randomized, double-blind, placebo-controlled, multicenter, crossover trial.

Setting: Outpatient clinics in Central Northern Italy.

Patients: 15 sequential patients positive for HIV-1 with platelet counts less than 25 × 109/L who were refractory to 1 month of full-dose (1000 mg/d) zidovudine.

Intervention: Interferon-α (3 million units) or placebo (1 mL saline) three times a week subcutaneously for 4 weeks, followed by a 4-week washout period. Patients were then switched to the alternative treatment for the next 4 weeks, followed by another 4 weeks of washout, and they were randomly assigned to either sequence of treatment. Patients received zidovudine (200 mg three times daily) throughout the study.

Measurements: The primary end point was the platelet count (measured weekly). Secondary end points were qualitative assessment of the platelet response; bleeding time; p24 antigen in serum; CD4/CD8 counts; β2-microglobulin in serum; and platelet-associated IgG.

Results: Interferon-α significantly increased platelet counts in the 12 patients who completed the study (baseline level, 15.6 ± 7.1 × 109/L; after 4 weeks of interferon-α therapy, 82.2 ± 52.2 × 109/L). The estimated increase in the platelet count after interferon-α compared with placebo was 60.0 × 109/L (95% CI, 23.2 to 96.8 × 109/L). The increase was already statistically significant after 3 weeks (66.6 ± 49.7 × 109/L) and remained significantly increased 1 week after discontinuing interferon-α therapy (58.2 ± 45.0 × 109/L). Placebo did not modify the platelet count. The bleeding time was significantly shortened by interferon-α. Four of 12 patients who had more serious alterations of some measures reflecting disease severity did not respond to interferon-α. No relevant side effects were observed.

Conclusions: Interferon-α is a safe and effective treatment for zidovudine-resistant, HIV-related thrombocytopenia.


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Figure 1.
Change in platelet counts during the study.nnnP

Average platelet counts in the 12 patients who completed the trial. Values represent the mean ± SD of all patients completing the study (black circles, = 12), of patients who responded (▴——▴, = 8), and of patients who did not respond (▵——▵, = 4) to interferon. Asterisks represent a significant difference when compared with baseline (basal) levels ( < 0.05).

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