Chronic pure red cell aplasia caused by parvovirus B19 in AIDS: Use of intravenous immunoglobulin - A report of eight patients

The optimal management of chronic pure red cell aplasia caused by parvoviru s B19 (B19-PRCA) in patients with AIDS is unclear. Our purpose was to deter mine the effects of intravenous immunoglobulin (IVIg) in the treatment of B 19-PRCA in patients with AIDS. The patients were eight adults with AIDS adm itted during the period 1993-1997, A diagnosis of B19-PRCA was made if all the following criteria were met: 1. Bone marrow biopsy finding of pure red cell aplasia; 2. Detection of parvovirus B19 DNA in serum; and 3. No altern ative explanation for PRCA. Initial (induction) therapy was with IVIg 1 g/k g daily for 1-2 days. Relapses were treated with IVIg 1 g/kg for 2 days. Ma intenance therapy with IVlg 0.4-1.0 g/kg q 4 weeks was given to those patie nts who developed a second or subsequent relapse. The patients were followe d for a mean of 27 months (range 8-38 months). All patients responded to in itial therapy with IVlg. Six patients with CD4 counts <80 cells/mm(3) relap sed. The response was short lived in two patients with a CD4 count <80 cell s/mm(3) who were given a single infusion of IVlg 1 g/kg as initial therapy. Four patients were given regular maintenance IVlg therapy following a seco nd or subsequent relapse and remain in remission. Two patients whose CD4 co unts were >300 cells/mm(3) remain in continuous unmaintained remission from B19-PRCA for over 8 and 11 months, respectively, following induction thera py with IVlg. AIDS patients with B19-PRCA respond well to therapy with IVlg 2 g/kg given over 2 days. Most patients with CD4 counts of less than or eq ual to 80 cells/mm3 suffer relapse within six months necessitating retreatm ent with IVlg; maintenance therapy with IVlg 0.4 g/kg q 4 weeks is effectiv e in preventing relapse of B19-PRCA, and may be cost effective. Routine mai ntenance therapy is probably not indicated in patients with CD4 counts over 300 cells/mm(3). Prospective studies are needed to confirm these findings. (C) 1999 Wiley-Liss, Inc.