Granulocyte colony-stimulating factor use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients

Philip Keiser, Steven Rademacher, James W. Smith, Daniel Skiest, Vinutha Vadde

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

BACKGROUND: Neutropenia occurs in up to 17% of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival. METHODS: A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI). RESULTS: The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm3 versus 40 cells/mm3, P = 0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P = 0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P = 0.002). In a multivariate analysis, significant decreased risk for bacteremia was found with G-CSF use (odds ratio [OR] = 0.15, P = 0.02). Survival was longer in patients treated with G- CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP. CONCLUSIONS: We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients.

Original languageEnglish (US)
Pages (from-to)48-55
Number of pages8
JournalAmerican Journal of Medicine
Volume104
Issue number1
DOIs
StatePublished - Jan 1998
Externally publishedYes

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Granulocyte Colony-Stimulating Factor
Bacteremia
HIV
Survival
Pneumocystis Pneumonia
Neutropenia
Multivariate Analysis
Opportunistic Infections
CD4 Lymphocyte Count
Proportional Hazards Models
Bacterial Infections
Medical Records
Cohort Studies
Therapeutics
Retrospective Studies
Odds Ratio

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Granulocyte colony-stimulating factor use is associated with decreased bacteremia and increased survival in neutropenic HIV-infected patients. / Keiser, Philip; Rademacher, Steven; Smith, James W.; Skiest, Daniel; Vadde, Vinutha.

In: American Journal of Medicine, Vol. 104, No. 1, 01.1998, p. 48-55.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Neutropenia occurs in up to 17{\%} of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival. METHODS: A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI). RESULTS: The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm3 versus 40 cells/mm3, P = 0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P = 0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P = 0.002). In a multivariate analysis, significant decreased risk for bacteremia was found with G-CSF use (odds ratio [OR] = 0.15, P = 0.02). Survival was longer in patients treated with G- CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP. CONCLUSIONS: We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients.",
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N2 - BACKGROUND: Neutropenia occurs in up to 17% of human immunodeficiency virus (HIV)-infected individuals. Although granulocyte colony-stimulating factor (G-CSF) can reverse HIV-related neutropenia, it is not established that this therapy can reduce bacterial infections and affect survival. METHODS: A retrospective cohort study of 152 neutropenic, HIV-infected patients was performed to determine the therapeutic utility of G-CSF. Medical records of 71 patients who received G-CSF and 81 patients who never received G-CSF, during the years of 1991 to 1994 at Parkland Memorial Hospital, were reviewed for the incidence of bacteremia, G-CSF use, antiretroviral therapy (AR), Pneumocystis carinii pneumonia prophylaxis (PCPP), and opportunistic infections (OI). RESULTS: The two patient groups had similar baseline characteristics including CD4 count (37 cells/mm3 versus 40 cells/mm3, P = 0.7). Univariate analysis revealed and trend toward decreased rates of all bacteremias in the G-CSF-treated group compared with the controls (0.54 bacteremias/100 patient months versus 2.2 bacteremias/100 patient months, P = 0.064) and a marked decrease in the rates of gram-negative rod bacteremias in the G-CSF-treated group compared with the untreated group (0.09 gram-negative rod bacteremias/100 patient months versus 1.7 gram-negative rod bacteremias/100 patient months, P = 0.002). In a multivariate analysis, significant decreased risk for bacteremia was found with G-CSF use (odds ratio [OR] = 0.15, P = 0.02). Survival was longer in patients treated with G- CSF than in the untreated group (median: 397 days versus 165 days). Multivariate analysis using Cox Proportional Hazards Model showed decreased risk of death in patients treated with G-CSF, ARs, PCPP. CONCLUSIONS: We conclude that G-CSF use is associated with decreased bacteremias and is associated with prolonged survival in neutropenic, HIV-infected patients.

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