A randomized controlled trial of palifermin (recombinant human keratinocyte growth factor) for the treatment of inadequate CD4+ T-lymphocyte recovery in patients with HIV-1 infection on antiretroviral therapy.

Abstract

BACKGROUND:

Poor CD4 lymphocyte recovery on antiretroviral therapy (ART) is associated with reduced function of the thymus. Palifermin (keratinocyte growth factor), by providing support to the thymic epithelium, promotes lymphopoiesis in animal models of bone marrow transplantation and graft-versus-host disease.

METHODS:

In AIDS Clinical Trials Group A5212, a randomized, double-blind, placebo-controlled study, 99 HIV-infected patients on ART with plasma HIV-1 RNA levels ≤200 copies per milliliter for ≥6 months and CD4 lymphocyte counts <200 cells per cubic milliliter were randomized 1:1:1:1 to receive once daily intravenous administration of placebo or 20, 40, or 60 μg/kg of palifermin on 3 consecutive days.

RESULTS:

The median change in the CD4 T-cell count from baseline to week 12 was not significantly different between the placebo arm [15 (-16, 23) cells/mm] and the 20-μg/kg dose [11 (2, 32) cells/mm], the 40-μg/kg dose [12 (-2, 25) cells/mm], or the 60-μg/kg dose arm [8 (-13, 35) cells/mm] of palifermin. No significant changes were observed in thymus size or in the number of naive T cells or recent thymic emigrants.

CONCLUSIONS:

Palifermin in the doses studied was not effective in improving thymic function and did not raise CD4 lymphocyte counts in HIV-infected patients with low CD4 cell counts despite virologically effective ART.

• Authors: Jeffrey M Jacobson, Hongying Wang, Rebeka Bordi, Lu Zheng, Barry H Gross, Alan L Landay, John Spritzler, Jean-Pierre Routy, Constance Benson, Judith Aberg, Pablo Tebas, David W Haas, Jennifer Tiu, Kristine Coughlin, Lynette Purdue, Rafick-Pierre Sekaly, AIDS Clinical Trials Group (ACTG) A5212 Protocol Team
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 66 Issue 4 Pg. 399-406 (Aug 01 2014) ISSN: 1944-7884 [Electronic] United States
• PMID: 24815851 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Anti-HIV Agents
• RNA, Viral
• Recombinant Proteins
• Fibroblast Growth Factor 7

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• CD4 Lymphocyte Count
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Fibroblast Growth Factor 7 (administration & dosage, pharmacology)
• HIV Infections (drug therapy, immunology)
• HIV-1
• Humans
• Male
• Middle Aged
• RNA, Viral
• Recombinant Proteins
• Thymus Gland (drug effects)
• Viral Load