Sc. Piscitelli et al., A risk-benefit assessment of interleukin-2 as an adjunct to antiviral therapy in HIV infection, DRUG SAFETY, 22(1), 2000, pp. 19-31
Immunomodulation has become a major focus of HIV research in an effort to a
ugment, boost or restore the patient's damaged immune system. Recombinant i
nterleukin-2 is currently being studied in phase II/III trials in HIV-infec
ted patients. Several clinical studies have demonstrated that intermittent
regimens are associated with marked rises in CD4+ cell counts without an in
crease in viral load. Most of these studies employ 5 consecutive days of in
terleukin-2 therapy by continuous intravenous infusion or subcutaneous inje
ction, repeated every 8 weeks. An alternative strategy is the daily adminis
tration of low doses of interleukin-2, but clinical experience with this re
gimen is limited.
Interleukin-2 administration can adversely affect virtually every organ sys
tem, requiring aggressive supportive care. A variety of administration stra
tegies and interventions are being evaluated to minimise toxicity.
Currently, no clinical end-point data are available for interleukin-2 in HI
V-infected patients. Until phase III studies are completed, interleukin-2 c
an be used in the research setting as an immunomodulator and adjunct to ant
iretroviral therapy. Its potential to activate latently infected cells and
promote HIV eradication from reservoir sites is also an important area for
further study. If clinical benefit can be demonstrated, interleukin-2 could
be useful as an adjunct to antiretroviral therapy if adverse effects can b
e minimised and therapy can be given infrequently on an outpatient basis.