IMMUNOMODULATORY TREATMENT OF MYCOBACTERIUM-AVIUM COMPLEX BACTEREMIA IN PATIENTS WITH AIDS BY USE OF RECOMBINANT GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR

Eight AIDS patients with Mycobacterium avium complex (MAC) bacteremia were randomized to receive azithromycin with or without granulocyte-ma crophage colony-stimulating factor (GM-CSF) for 6 weeks to examine the effect of GM-CSF administration on clearance of mycobacteremia and on monocyte function. Superoxide anion production was significantly incr eased ex vivo in monocytes from patients receiving GM-CSF but not in t hose from patients receiving azithromycin alone, Relative to monocytes obtained from untreated healthy controls, median differences in viabl e intracellular MAC at 2, 4, and 6 weeks were -0.76, -0.94, and -0.47 log(10) cfu/mL of lysate for cells from patients receiving GM-CSF vers us -0.15, -0.11, and -0.19 log(10) cfu/mL for cells from patients rece iving azithromycin alone, Although no effect on mycobacteremia was det ected, the administration of GM-CSF to AIDS patients with MAC bacterem ia resulted in activation of their blood monocytes, as evidenced by in creased superoxide anion production and enhanced mycobactericidal acti vity. GM-CSF deserves further investigation in the treatment of mycoba cterial infections.