(1)
Neutropenia is frequent in patients with
AIDS and is an added risk factor for
infection. There is no specific treatment, except, when feasible, the withdrawal of a suspected culprit
drug. (2)
Filgrastim, a granulocyte
growth factor, has been granted a license extension to cover the treatment of persistent
neutropenia in patients at an advanced stage of
HIV infection. (3) Only one comparative, unblinded trial has been published in this setting. It involved 258 patients distributed into three groups, who received daily
filgrastim, intermittent
filgrastim, or no treatment. Six months after the beginning of the trial,
filgrastim had not reduced the number of deaths, the number of hospital days, or the risk of bacterial or
fungal infection. (4) The trial report fails to show whether
filgrastim influences viral load or the CD4+ lymphocyte count. (5) In the absence of published dose-finding studies there is no proof that the dose regimen recommended in the licensing terms is the one with the best risk-benefit ratio. (6) Treatment with
filgrastim is costly, especially as the available unit doses are unsuitable for this indication. (7) Patients at an advanced stage of
HIV infection are already heavily medicated. There is no reason to add
filgrastim, which has no proven clinical value.