Pharmacokinetics, Toxicity, and Activity of Intravenous Dextran Sulfate in Human Immunodeficiency Virus Infection

In 1991, a study involving 10 subjects with symptomatic HIV infection tested the anti-HIV activity of intravenous dextran sulfate. Despite achieving plasma concentrations far exceeding the amount needed to inhibit HIV in vitro, the drug led to a significant increase in circulating HIV antigen levels, with a median increase of 73.5% in subjects treated for more than three days. All subjects who received the drug for over three days developed severe but reversible thrombocytopenia, and five experienced extensive but reversible alopecia. The study concluded that dextran sulfate is not a practical treatment for HIV due to its toxicity and lack of beneficial effects on surrogate markers. The increase in HIV antigen levels indicated a potential proviral effect or an impact on the virus's clearance from plasma. The study also noted that the drug's total clearance declined over time, possibly due to saturation of the reticuloendothelial system, and advised caution in the clinical evaluation of similar compounds.