A Double-Blind, Placebo-Controlled Trial To Evaluate Intravenous Gamma Globulin in Children With Symptomatic HIV Infection Receiving Zidovudine

Inclusion Criteria

Concurrent Medication:

Allowed:

• Benadryl and/or acetaminophen may be given before and during intravenous immunoglobulin (IVIG) infusion in patients demonstrating mild reactions during infusion.
• Acetaminophen for short-term fever and pain.
• Zidovudine (AZT).
• Steroids.
• Oral or systemic (swish and swallow) nystatin.
• Maintenance therapy for fungal disease or tuberculosis.
• Prophylaxis for a previous episode of Pneumocystis carinii pneumonia (PCP) including the use of trimethoprim / sulfamethoxazole (TMP / SMX). The dosage is specified as TMP 75 mg/m2 twice daily 3 times a week and SMX 375 mg/m2 twice daily 3 times a week.
• Recommended:
• Children with AIDS and / or CD4 count = or < 500 cells/mm3 should receive primary PCP prophylaxis as described.

Concurrent Treatment:

Allowed:

• Blood transfusion for hemoglobin < 8 g/dl and hematocrit < 24 percent or bone marrow suppression.
• Supplemental oxygen with a prestudy PaO2 < 70 mmHg.

Children must have one or more of the indicator diseases of AIDS; however, there must be an absence of acute opportunistic infection and an absence of bacterial infection requiring treatment at the time of entry into the study.

• Children with lymphoid interstitial proliferation (LIP) are excluded from enrollment unless they have had additional AIDS-defining opportunistic infections, meet ARC criteria, have had two or more serious bacterial infections in the 12 months prior to study entry, have evidence of HIV encephalopathy, or are currently on supplemental oxygen and steroids with a pre-treatment PaO2 < 70 mm Hg.
• Children with concurrent LIP and ARC are eligible for inclusion. Thrombocytopenia is an exclusion except if it is HIV-associated.
• Children randomized prior to their 13th birthday are eligible.
• All lab values must be within 4 weeks of study entry.

Prior Medication:

Allowed:

• Zidovudine (AZT).

Exclusion Criteria

Co-existing Condition:

Patients with the following will be excluded:

• Lymphoid interstitial proliferation (LIP) not requiring steroids and supplemental oxygen or with other lymphoproliferative diseases as their sole clinical evidence of HIV infection.
• Known hypersensitivity to immunoglobulin.
• Active HIV thrombocytopenia requiring IVIG therapy.

Concurrent Medication:

Excluded:

• Chronic acetaminophen.
• Drugs that are metabolized by hepatic glucuronidation should not be used for more than 24 hours without notifying the study physician.
• Antibacterial prophylaxis for otitis, sinusitis, or urinary tract infection.
• Prophylaxis treatment for Pneumocystis carinii pneumonia (PCP) prior to the first episode of laboratory-documented PCP.
• Immunoglobulin (IVIG) therapy required for active HIV thrombocytopenia.

Patients with the following will be excluded:

• Lymphoid interstitial proliferation (LIP) not requiring steroids and supplemental oxygen or with other lymphoproliferative diseases as their sole clinical evidence of HIV infection.
• Known hypersensitivity to immunoglobulin.
• Active HIV thrombocytopenia requiring IVIG therapy.
• Inability to establish or maintain intravenous access.
• Lack of parental or guardian authorization for intravenous access.

Prior Medication:

Excluded within 4 weeks of study entry:

• Any other experimental therapy.
• Other antiretroviral agents.
• Drugs which cause prolonged neutropenia or significant nephrotoxicity.
• Immunoglobulins.
• Immunomodulating agents.

Active alcohol or drug abuse.

History of severe allergic reactions to study medication Currently pregnant or breastfeeding Recent participation in another clinical trial within the last 30 days Presence of uncontrolled medical conditions that could affect safety