Interleukin-2 (IL-2, Proleukin)

March 2007 View PDF En español

Dosing considerations

Studied doses that appear to greatly impact CD4+ cell increases:

Daily subcutaneous injection (under the skin) with starting doses of 9–15 MIU (4.5–7.5 MIU, twice daily), five consecutive days, every eight weeks. Lower doses have been used, resulting in less significant CD4+ cell count increases.
Continuous IV (in the vein) infusion of 9–12 MIU, daily, five consecutive days, every eight weeks. This approach is associated with greater and more severe side effects and may only be desirable for people who fail to achieve CD4+ cell count increases using subcutaneous injections. People using IL-2 in this way are encouraged to do so in a hospital setting. This IV approach is rarely ever used today, though it was standard for the lion’s share of early research on IL-2.

Dosing strategies to consider:

Reduce dosing to manage side effects in increments of three million IU (15 to 12, 12 to 9, etc.). You should also take antihistamines and ibuprofen before starting IL-2.
If you use subQ IL-2 and experience no CD4+ cell increases, in studies some success has been observed in those switching to CIV IL-2. (Note: People who start IL-2 with lower CD4+ cell counts may take longer to experience increases in CD4+ cell count; in any case, people should not assume a dose isn’t working unless it has been used for six months or longer).
If you use IV IL-2 and experience pronounced and sustained CD4+ cell increases, consider switching to maintenance therapy with subQ injections.
If CD4+ cell counts are high and sustained (above 600), consider increasing the time between IL-2 dosing in four week increments (every twelve weeks instead of eight). If CD4+ cell counts remain high after lengthening time between IL-2 therapy for three cycles, consider increasing it again, in four-week increments (8 to 12 weeks, 12 to 16 weeks, etc.).

IL-2 and CD4+ Cell Count, Viral Load and General Health

Measure CD4+ cell and viral levels before taking IL-2 (preferably getting results before starting a five-day course).
If viral levels are high or increasing, consider re-evaluating your anti-HIV regimen (read Project Inform’s publication, Anti-HIV Therapy Strategies). Consider delaying IL-2 therapy until viral levels are under control.
If you experience an active infection or condition, consider delaying five-day IL-2 course of therapy until it’s resolved. IL-2 therapy temporarily suppresses the immune system and may interfere with your body’s ability to fight off infection in the short term.

IL-2 and Other Therapy

Maintain optimal anti-HIV therapy while on IL-2, preferably a three-drug combination.
Regardless of CD4+ cell impact from IL-2, consider continuing preventive therapy for opportunistic infections (PCP, etc.) if it was warranted before starting IL-2. Be cautious and conservative about stopping preventive therapy when CD4+ cell counts rise. The value of IL-2 therapy and CD4+ cell count increases realized as a result of therapy is still not known.

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Dosing considerations