[Effect of factor VIII concentrates of very high purity on CD4+ cell count in hemophiliacs infected with HIV]

OBJECTIVES

To analyze the effect of high purity factor VIII concentrates on CD4+ cell counts in HIV-seropositive hemophiliac patients.

PATIENTS AND METHODS

A study was conducted with 16 HIV seropositive patients with severe hemophilia A (mean age: 20 years) free from anti-retroviral therapy and with CD4+ cell counts higher than 200/microliters who had their intermediate purity factor VIII concentrates changes to high purity concentrates immunoadsorbed with monoclonal antibodies (monoclonal FVIII). For each patient two consecutive period were compared, one before (median: 21 months) and the other after (median: 19 months) the therapeutic change. All patients had three or more CD4+ cell counts determined in each period, which were used to calculate the slope with time (CD4+/microliters/month and % variation/month). The Wilcoxon test was used for statistical comparisons among paired tests.

RESULTS

No significant differences were observed among the mean values of the initial (656 +/- 246/microliters), change time (625 +/- 277/microliters) and final counts (493 +/- 246/microliters). During the intermediate purity period slopes (mean: -0.6 +/- 12 CD4+/microliters/month) were not significantly different from zero. In contrast, they were significant during the period of treatment with monoclonal FVIII (mean: -8.5 +/- 14 CD4+/microliter/month; p < 0,05). Nevertheless, differences between the slopes of the two periods were not statistically significant.

CONCLUSION

In contrast with the results obtained in prospective studies, no favorable effect of monoclonal FVIII on CD4+ cell counts was observed among HIV-positive hemophiliac patients.