Abstract
Eight AIDS patients with Mycobacterium avium complex (MAC) bacteremia were randomized to receive azithromycin with or without granulocyte-macrophage colony-stimulating factor (GM-CSF) for 6 weeks to examine the effect of GM-CSF administration on clearance of mycobacteremia and on monocyte function. Superoxide anion production was significantly increased ex vivo in monocytes from patients receiving GM-CSF but not in those from patients receiving azithromycin alone. Relative to monocytes obtained from untreated healthy controls, median differences in viable intracellular MAC at 2, 4, and 6 weeks were -0.76, -0.94, and -0.47 log10 cfu/mL of lysate for cells from patients receiving GM-CSF versus -0.15, -0.11, and -0.19 log10 cfu/mL for cells from patients receiving azithromycin alone. Although no effect on mycobacteremia was detected, the administration of GM-CSF to AIDS patients with MAC bacteremia resulted in activation of their blood monocytes, as evidenced by increased superoxide anion production and enhanced mycobactericidal activity. GM-CSF deserves further investigation in the treatment of mycobacterial infections.
Publication types
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Clinical Trial
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
MeSH terms
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AIDS-Related Opportunistic Infections / microbiology
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AIDS-Related Opportunistic Infections / therapy*
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Adjuvants, Immunologic / administration & dosage
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Adjuvants, Immunologic / pharmacology
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Adjuvants, Immunologic / therapeutic use*
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Adult
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Anti-Bacterial Agents / administration & dosage
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Anti-Bacterial Agents / pharmacology
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Anti-Bacterial Agents / therapeutic use
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Azithromycin / administration & dosage
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Azithromycin / pharmacology
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Azithromycin / therapeutic use
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Bacteremia / therapy*
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Drug Therapy, Combination
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Female
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Granulocyte-Macrophage Colony-Stimulating Factor / administration & dosage
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Granulocyte-Macrophage Colony-Stimulating Factor / pharmacology
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Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use*
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Humans
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Male
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Microbial Sensitivity Tests
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Monocytes / immunology
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Monocytes / metabolism
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Monocytes / physiology
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Mycobacterium avium Complex / drug effects
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Mycobacterium avium-intracellulare Infection / blood
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Mycobacterium avium-intracellulare Infection / therapy*
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Superoxides / analysis
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Superoxides / metabolism
Substances
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Adjuvants, Immunologic
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Anti-Bacterial Agents
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Superoxides
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Granulocyte-Macrophage Colony-Stimulating Factor
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Azithromycin