Successful treatment of aphthous ulcerations in AIDS patients using topical granulocyte-macrophage colony-stimulating factor

Oral recurrent aphthous ulceration (RAU) is a well-recognized complication in patients infected with human immunodeficiency virus. RAU can be progress ive and destructive, causing dysphagia and secondary malnutrition. The aeti ology of RAU remains unknown, and its response to available treatments is o ften unsatisfactory, We describe three patients with advanced AIDS who suff ered from extensive RAU which failed to respond to several treatments, incl uding topical viscous lidocaine and topical and systemic glucocorticoids, O wing to difficulties in using thalidomide (two patients had neurological co nditions which precluded thalidomide use), all three patients were treated with an oral solution containing recombinant human granulocyte-macrophage c olony-stimulating factor (GM-CSF 400 mu g in 5% glucose 200 mt). From the f irst application, all three patients showed significant improvement of thei r lesions and amelioration of pain, and they were completely cured in a few days. No adverse effects were recorded, The patients did not show relapses of RAU over a prolonged follow-up. Controlled trials are warranted in orde r to establish the role of GM-CSF as a valid, alternative option for aphtho us ulcerations of the mouth in AIDS patients in whom corticosteroids or tha lidomide are not suitable.