Cytokines as antimicrobial therapy for the T cell-deficient patient: Prospects for treatment of nonviral opportunistic infections
Patients rendered T cell-deficient by advanced disease due to human immunodeficiency virus, an underlying neoplastic disorder, or immunosuppressive therapy are vulnerable to a select group of opportunistic infections. These infections, which often fail to respond to conventional therapy, provide the clinical setting in which the efficacy of treatment with cytokines can be tested. Particularly pertinent cytokines are those that activate macrophages and monocytes or enhance T-cell function. Experimental observations and emerging data from patients with intact T-cell function suggest that treatment with at least three cytokines, interferon-gamma, interleukin-2, and granulocyte-macrophage colony-stimulating factor (GM-CSF) may be of benefit. Each of these cytokines is already in clinical use, and each has therapeutic potential in a variety of different infectious disease. Patients with infections caused by opportunistic intracellular pathogens appear to be the most appropriate candidates for adjunctive cytokine therapy.