Immunoglobulin preparations for HIV-infected patients.

Patients with the acquired immunodeficiency syndrome (AIDS) suffer from a deficiency of cellular immunity. However, some HIV-infected children and adults suffer from recurrent upper respiratory tract infections suggestive of a failure to synthesise specific antibodies, despite the hypergammaglobulinaemia that is present. Intravenous immunoglobulin (IV IgG) appears to benefit HIV-infected children with recurrent infections, in doses similar to those used for treating patients with primary hypogammaglobulinaemia. In some HIV-infected adults, IV IgG also appears to reduce bacterial respiratory infections but the treatment schedules remain to be defined. In patients with life-threatening bleeding due to immune thrombocytopenic purpura associated with HIV infection, high dose IV IgG treatment (1-2 g/kg) also increases platelet counts but unlike other therapies for ITP, is not immunosuppressive and has no other serious adverse effects. It is likely that over the next few years, specific anti-HIV preparations will be evaluated. Neutralising antibody has been demonstrated in HIV-infected patients and a specific antibody preparation against HIV might either prevent HIV infection after initial exposure to the virus or slow the progression of HIV-related disease. However, the development of a specific, effective, neutralising anti-HIV immunoglobulin preparation (whether polyclonal or monoclonal) will require information about which HIV antigens elicit protective immunity and the role played by neutralising antibody in HIV-related disease.