Davey R T, Davey V J, Metcalf J A, Zurlo J J, Kovacs J A, Falloon J, Polis M A, Zunich K M, Masur H, Lane H C
Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892.
J Infect Dis. 1991 Jul;164(1):43-52. doi: 10.1093/infdis/164.1.43.
Twenty-four patients infected with human immunodeficiency virus type 1 (HIV-1) who had CD4+ counts of 0.2-0.5 x 10(9) cells/l received granulocyte-macrophage colony-stimulating factor (GM-CSF) in combination with zidovudine plus escalating doses of daily subcutaneous interferon-alpha. Mean neutropenia-inducing doses of interferon-alpha were 9.4 x 10(6) and 10.6 x 10(6) IU/day for groups receiving 100 or 200 mg zidovudine every 4 h, respectively. Mean GM-CSF doses used to reverse neutropenia were 0.64 and 0.63 microgram/kg/day for these two groups, respectively, although the mean minimum effective GM-CSF dose for both was only 0.30 microgram/kg/day. Serum p24 antigen declined greater than 70% in all 5 antigenemic patients. Toxicities included a dose-dependent increase in lymphokine-like side effects (100%), anorexia and weight loss (42%), fatigue (42%), and anemia (50%). While toxicities of the combination can be significant, low-dose GM-CSF readily ameliorated neutropenia associated with zidovudine and interferon-alpha therapy without adversely affecting the antiviral properties of the combination.
24例1型人类免疫缺陷病毒（HIV-1）感染者，其CD4 +细胞计数为0.2 - 0.5×10⁹个细胞/升，接受了粒细胞-巨噬细胞集落刺激因子（GM-CSF）联合齐多夫定以及每日递增剂量的皮下注射α干扰素治疗。对于每4小时接受100或200毫克齐多夫定的组，诱导中性粒细胞减少的α干扰素平均剂量分别为9.4×10⁶和10.6×10⁶国际单位/天。用于逆转中性粒细胞减少的GM-CSF平均剂量在这两组中分别为0.64和0.63微克/千克/天，尽管两组的平均最低有效GM-CSF剂量仅为0.30微克/千克/天。所有5例有抗原血症的患者血清p24抗原下降超过70%。毒性反应包括细胞因子样副作用剂量依赖性增加（100%）、厌食和体重减轻（42%）、疲劳（42%）以及贫血（50%）。虽然联合治疗的毒性可能很显著，但低剂量GM-CSF可轻易改善与齐多夫定和α干扰素治疗相关的中性粒细胞减少，且不会对联合治疗的抗病毒特性产生不利影响。
