ERYTHROPOIETIN FOR ZIDOVUDINE-ASSOCIATED ANEMIA IN CHILDREN WITH HIV-INFECTION

In a pilot study we evaluated the effect of subcutaneously or intraven ously administered erythropoietin in pediatric patients who developed anemia (hemoglobin < 8 g/dl) or transfusion dependency while on zidovu dine, in spite of dosage reductions to 120 mg/m2 q 6h, in order to det ermine whether tolerance of zidovudine could be improved. Between Apri l 1990 and February 1993 12 patients between 8 months and 17.4 years o ld, all Center for Disease Control and Prevention (CDC) class P2, were enrolled, 8 of whom were available. Endogenous erythropoietin. levels were under 200 IU/L in all but one patient. We used a sliding dosing schedule of erythropoietin in order to maintain the hemoglobin between 11-13 g/dl. Patients were on study for a mean of 31.5 weeks (range 14 -85 weeks); six patients died of progressive HIV disease, and two were switched to other antiretroviral regimens. Erythropoietin was very we ll tolerated in all children. With doses of erythropoietin ranging bet ween 150-400 U/kg subcutaneously or intravenously every Monday, Wednes day, and Friday, all patients were able to tolerate and be maintained on doses of zidovudine between 120-180 mg/m2 every 6 hours (480-720 mg /m2 per day). Transfusion requirement for packed red blood cells dimin ished markedly in four patients, and moderately in the other four. Ery thropoietin appears to be beneficial in a selected group of HIV-positi ve children with zidovudine-related bone marrow suppression and enable s them to continue receiving therapeutic doses of zidovudine.