Treatment of human immunodeficiency virus-related thrombocytopenia with intravenous anti-rhesus D immunoglobulin.

SIR-The recent paper by Glatt and Anand [1] provides an excellent, comprehensive review of the natural history and treatment options with regard to HIV-related thrombocytopenia. We wish to discuss the efficacy of therapy with intravenous anti-rhesus D (Rho[D]) immunoglobulin in this setting. Glatt and Anand state that the drawbacks to intravenous anti-RHo(D) include lack of experience with its use in patients with HIV-related thrombocytopenia and the fact that it is in short supply. In fact, data exist for at least 100 HIV-infected patients treated with anti-RHo(D). In addition to the 17 patients treated by Busse1 et al. [2] (who were cited by Glatt and Anand [1]), Rossi et al. [3] have described 21 patients with HIV-related thrombocytopenia (mean baseline platelet count, 11.6 X 109/L) who were treated with low doses of anti-RHo(D) and weekly maintenance therapy. Among these patients, the mean platelet count during maintenance therapy was 68.4 X 109IL, with no apparent clinical hemolysis. Oksenhendler et al. [4] described 14 HIV-infected patients (each of whom had a baseline platelet count of <20 X 109IL) who were treated with one of two regimens of anti-Rho(D); each regimen consisted of a total dose of 2434 p,g/kg. Nine of these 14 patients had satisfactory initial responses, with platelet counts that increased to ~50 X 109/L by days 3-12; platelet counts remained >25 X 109/L during days 11-37, with no clinically apparent hemolysis. We now have had experience with 65 patients (including the 17 patients previously described by Bussel et al.) with all Walter Reed classes of HIV infection and secondary immune thrombocytopenic purpura (lTP) who were treated with intravenous human