AIDS TREATMENT NEWS No. 104 - June 1, 1990
John S. James

According to a brief written report by doctors Kenneth Alonso and William D. Logan Jr. of the Atlanta Heart and Lung Clinic at Atlanta Hospital, the patient had worsening KS and a T-helper count of 50 before beginning the treatment. AZT and alpha interferon had not prevented the symptoms from worsening.

Institutional Review Board gave permission to try hyperthermia.

Using tubes inserted in an artery and a vein in the thigh, blood was withdrawn, heated outside the body with a heat exchanger, and then put back into the circulation. With temperature carefully monitored by thermometers in the pulmonary artery and in the bladder, body temperature was gradually raised to 42 degrees C (between 107 and 108 degrees F) for two hours. The patient, who was under general anesthesia, was then cooled gradually. Lesions started to improve within 48 hours, and by seven days some were less than half of their original size. Maximum improvement had occurred at six weeks; some but not all of the lesions had disappeared. The patient's T-helper count had increased from 50 to 330. HIV cultures were negative (which may mean little, however, because of the unreliability of most viral cultures), and reverse transcriptase in the blood (a measure of viral activity) had fallen by 70 percent.

The physicians submitted a report of this case for publication in a medical journal. When the story got into the press, they insisted that the treatment was not a cure. But some of the press reports suggested that despite the doctors' caution, the patient believed he was cured. Extensive coverage has led to hundreds of phone calls to the physicians and to AIDS service organizations.

Comment

It is hard to evaluate this report without detailed peer review. Most AIDS experts reached by reporters have been reluctant to say much on the record until they know more. Most do seem to agree that the treatment might be useful, and that it must be investigated further.

Why would a report of a single case lead to national publicity? May is a "sweeps" month, when the audiences of TV stations are carefully measured in order to set advertising rates, and when, therefore, the stations do everything possible to boost their audiences. One media expert speculated that if the report had arrived a few days later, in June, it would not have been a story.

It is unfortunate when widespread reporting raises hopes prematurely. But in this case the publicity may also have made an important contribution. Despite the widespread agreement that the treatment might be useful and should be investigated, there is a serious risk that no followup trial will be organized. Hyperthermia has little commercial potential, since it generates only one sale of a relatively simple and inexpensive machine to each center which uses it; it does not lead to repeat sales, as pharmaceuticals do. Hyperthermia has no constituency in the government or in any part of the AIDS research establishment. Hopefully the widespread publicity will generate enough interest so that someone will follow up with a small trial.

Hyperthermia is dangerous if done improperly; it must be performed by knowledgeable physicians. Published articles on this technique describe extensive precautions which are taken for the patient's safety. If formal studies are not conducted, the treatment may instead come into use in the offices or clinics of physicians not trained to employ it properly. Fortunately, the procedure tried in one case with AIDS is exactly the same as that often used in treating cancer, meaning that the technology, staff training, precautions, risk estimates, etc. are already in place.

As far as we know, the patient in Atlanta is the only person with AIDS who has been treated with hyperthermia. The idea had previously been suggested; see References, below.

For More Information

For more information, physicians can write to Dr. Kenneth Alonso, 203-B Medical Way, Riverdale, GA 30274, phone 404/991- 1971.

Note: In a completely separate effort, Dr. Shawn Hankins, a chiropractor in Port Angeles, Washington, has been urging a test of hyperthermia since July, 1987. He points out that HIV is heat sensitive, and in addition, hyperthermia can cause increased T- cell proliferation, phagocytosis, and increased production of antibodies and interferon. Anecdotal observation, such as the "honeymoon effect" that sometimes follows pneumocystis (which causes a high fever) also supports this possibility. Dr. Hankins can be reached at 616 E. Front St., Port Angeles, WA 98362.

References

Brenner, S. HIV appears to have some susceptibility to heat [letter]. AIDS Research and Human Retroviruses, volume 5 number 1, pages 5-6, February 1989.

Bull, JM. A review of systemic hyperthermia. Front. Radiat. Ther. Onc., volume 18, pages 171-176, 1984.

Weatherburn, H. Hyperthermia and AIDS treatment [letter]. The British Journal of Radiology, volume 61 number 729, pages 863- 864, September 1988.

Yatvin, Milton B. An approach to AIDS therapy using hyperthermia and membrane modification. Medical Hypotheses, volume 27, pages 163-165, 1988.

News Flash Alonso to speak: Dr. Alonso is scheduled to speak about the hyperthermia treatment at the "alternative" AIDS conference in San Francisco, the Advanced Immune Discoveries Symposium, on Friday, June 22. For more information about this meeting, call the Foundation for Research of Natural Therapies, Foster City, CA 415/349-0718 (fax 415/349-1257).

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