The Optimum Use of Intravenous Immunoglobulin for Prophylaxis of Opportunistic Infection in HIV-Infected Adults

Abstract

Immunoglobulin therapy is well established in the treatment of HIV-infected children with frequent bacterial infections or recurrent severe bacterial infections, and the beneficial effects are well demonstrated. Such clear recommendations regarding intravenous immunoglobulin (IVIG) therapy are currently not available for adults. Several studies have been performed in adults to determine the effects of IVIG therapy in different dosages on the frequency and severity of infections, as well as on survival. Although most studies suffer from problems in design and low patient numbers, some conclusions can be drawn. The therapy is well tolerated and does not seem to have adverse effects on patients' immune functions. Most studies demonstrate beneficial results of IVIG treatment, especially on frequency and severity of infections in patients with advanced HIV disease. However, overall survival is, if at all, only slightly prolonged. Despite the observed beneficial effects, it is unclear whether these benefits justify the high costs of continuous IVIG therapy. The role of IVIG therapy could be further altered by the recent improvements in antiviral drug therapy. Taken together, the available data suggest an individualised usage of IVIG as adjunctive therapy in adults with advanced HIV infection and severe or recurrent bacterial infections.