AIDS and apheresis procedures--therapeutic and safety considerations

The role of therapeutic apheresis was assessed in a number of clinical syndromes associated with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC). Four groups of patients were studied: AIDS with opportunistic infections, AIDS with Kaposi's sarcoma, AIDS/ARC patients with peripheral neuropathy and a patient with AIDS-related immune thrombocytopenia. Intensive plasmapheresis was shown to have no significant effects on the disease course of patients with full-blown AIDS. However, intensive plasma exchange restored normal neurologic function in the majority of patients with AIDS/ARC-related peripheral neuropathy. Selective immunoadsorption by means of protein A columns led to a sustained normalization of platelet counts in a patient with severe immune thrombocytopenia. A phase I study of AIDS-related Kaposi's sarcoma demonstrated that protein A immunoadsorption was tolerated well and was accompanied by partial responses. Patients being plasmapheresed for conditions other than AIDS were not found to be at any greater risk for acquiring AIDS-related viruses. Finally, health care professionals performing apheresis procedures on AIDS patients were not shown to be at increased risk of contracting AIDS-related viruses provided reasonable blood precautions were exercised.