The treatment of human immunodeficiency virus infected patients with intravenous immunoglobulin.

The main immunological abnormality described in patients with the acquired immunodeficiency syndrome (AIDS) is the deficiency in cellular immunity. However, there is increasing evidence of a deficiency of specific antibody synthesis in both symptomatic human immunodeficiency virus (HIV)-infected children and in some HIV-infected adults who are symptomatic or who suffer from AIDS. In uncontrolled studies as well as those using historical controls, iv immunoglobulin (IVIG) has been shown to benefit HIV-infected children with recurrent infection when used in doses similar to those needed to treat patients with primary hypogammaglobulinaemia. Preliminary data in adults show that IVIG therapy reduces bacterial infection but the optimal treatment schedules remain to be defined. In addition, high-dose IVIG treatment (1-2 g kg-1) produces increased platelet counts in patients with life-threatening bleeding due to idiopathic thrombocytopenic purpura associated with HIV infection. Unlike other therapies, IVIG has the advantage of lacking immunosuppressive and other serious adverse effects. In HIV-infected patients, IgG therapy may limit the antigenic stimulation caused by intercurrent infection, and studies of asymptomatic patients are needed in order to investigate whether this might slow the progression to AIDS. Neutralizing antibody against HIV has been demonstrated in HIV-infected patients. Although the significance of this finding is not clear, a specific antibody preparation against HIV may be of value either to prevent HIV infection after initial exposure to the virus or to slow the progression of HIV-related disease. Major difficulties will be encountered in producing a specific, effective, neutralizing anti-HIV immunoglobulin preparation, since it is not known which HIV antigens elicit protective immunity.