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What is the rationale for the difference in chemotherapy dosage for HIV versus non HIV Patients?
Mar 24, 2002

Dr Dezube: Could you explain to me the rationale for the diluted dosage of chemotherapy for HIV versus full strength for non-HIV patients for non-Hodgkin's lymphoma. Would diluted chemotherapy cause the patient to relapse? Also why is 300 micrograms of Neupogen standard for HIV patients versus 480 micrograms in non-HIV NHL patients. Thank you so much for your kind work.

Response from Dr. Dezube

I actually don't like the word "diluted dosage" since it conveys, at least to me, that the chemotherapy is watered down. This is hardly the case. Non-HIV patients should receive "standard dose" of chemotherapy unless there's a good reason for them not to do so. HIV-infected patients should also receive "standard dose" provided they are "reasonably healthy". Occasionally we dose-reduce the chemotherapy by as much as 50% in HIV-infected patients who are "fragile". Although it's hard for me to give a firm definition of whom I would view as fragile, a patient who is confined to bed 100% of the time, with a CD4 count in single digits, and suffering from ongoing pneumocystis pneumonia and CMV retinitis would be such a case (I recently had such a patient). That said, most HIV patients should receive full dose.

In a New England Journal of Medicine article, which I co-authored, we showed that for the more "fragile" HIV-infected patient, half-dose chemotherapy works about as well as full-dose.

In terms of neupogen, I use 300 micrograms for both HIV and non-HIV patients. It works quite well. I use 480 micrograms only in very, very large patients, for example those who are the size of the football players on SuperBowl Sunday. Interestingly enough, HIV-infected patients often respond better to neupogen than HIV-negative patients.

So instead of "diluted" chemotherapy, the proper term is "dose-reduced". Hope this clarifies the situation.


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