Being Alive Newsletter; July 1992
Stephan Korsia

Before the advent of AIDS, immune boosting meant to temporarily increase the effectiveness of the immune system to fight an infection more quickly or to prevent infections from becoming symptomatic. Nowadays, immune boosters are also proposed as long-term treatments to help the immune system keep HIV and opportunistic infections in control. People with HIV have been conditioned to seek therapies that will boost their immune system mainly because HIV disease is always presented as a deficiency that requires correcting.

Media and researchers have consistently presented symptomatic persons with HIV as not being immunocompetent, and in bad need of a kick in their immunological ass. This attitude has a profound influence on the way people with HIV see themselves, on what they are expecting from a treatment, and on what AIDS research it trying to accomplish. Whether at Stanford University or at our favorite health food store, immune boosting has become a national sport. However, some of the players are starting to wonder whether there is a point to the game.

Recently, a wealth of scientific information has begun to accumulate that suggests that stimulating the immune system may be more harmful than beneficial, especially in people with early disease. Without being too technical, let's say that immune cells exist in two states: active and inactive. Inactive cells are activated when the body is exposed to an infection or anything else that requires an immune response. Researchers have known for a while that it is rather difficult, if not impossible, to infect an inactive immune cell with HIV. In addition, infected cells need to be activated to produce HIV particles. The consequence is that anything which stimulates immune cells (such as an infection by any of the well-publicized cofactors, or an immune booster) has the potential to both increase the production of virus by infected cells, and increase the vulnerability of uninfected cells to HIV. Do you smell the coffee?

In addition to this oh-so-minor inconvenience, scientists are starting to find evidence that HIV might not be the killer that we love to hate of T-cells. Several other studies seem to indicate that some T-cells may be falling victim of a yet-unsuspected assassin, the immune system itself! This hypothesis is often referred to as the "auto-immune" hypothesis. Auto-immune diseases are diseases in which the immune system goes bonkers and starts attacking part of the body itself. More and more researchers are beginning to believe that HIV can fool the immune system into pushing immune cells into a war against each other. Physicians often report many similar symptoms between HIV disease and Lupus (an auto-immune disease), as well as a significant incidence of auto-immune syndromes in people with HIV (against their platelets, their nerve endings, their skin). What will happen if you boost an immune system that is already overactive in a self-destructive manner?

Finally, a recent study from the Pasteur Institute published in the Journal of Experimental Medicine found that T4 cells from people with asymptomatic HIV disease have the unfortunate habit of committing suicide when activated by (guess what?) an immune booster (in this case, a substance isolated from the Pokeweed plant). T-cells, like many cells in the body, have the power to pull the trigger on themselves when told to do so, and this property might well play an important part in the loss of T4 cells observed in the late stages of HIV disease. So, still willing to run for anything that will stimulate T-cells?

When researchers started using Interleukin-2 to restore T-cells (Interleukin-2 is a natural "hormone" we secrete to increase the production of new T-cells), they observed that T-cell counts were increasing but so was the amount of HIV in patients' blood. Further studies used AZT to try to prevent this increased viral production. In every study of the immune-boosting effects of vaccines on people with HIV (such as gp 120 and gp 160), researchers are carefully studying the amount of HIV in each patient, as well as the eventual onset of auto-immune problems. However, nothing is known about the effects of other "immune boosters," such as Echinacea, Astragalus, Reishi and Shiitake mushrooms, and the dozens of other compounds that are floating around our communities. Are we putting oil on the fire by using these substances?

For years, reputable Oriental Medicine practitioners have described people with HIV disease as having an "unbalanced" immune system, rather than a deficient one. Qing Cai Zhang, MD, one of the authors of AIDS and Chinese Medicine and a practitioner in New York, recently gave a talk in Los Angeles where he proposed to change the meaning of the acronym AIDS to Acquired Immune Dysfunction (not Deficiency) Syndrome. Oriental practioners have been using herbs that are said to have both immunostimulant and immunosuppressive properties, depending upon whether one has an overactive or a deficient immune system. Examples of such "immunobalancing" plants are the Chinese Cucumber (from which Compound Q is extracted) and the local craze, bitter melon. Acupuncture is also claimed to regulate a dysfunctional immune system.

Western medicine is also looking into HIV treatments which may act by "cooling" a hyperactive immune system. Cyclosporine, a widely used immunosuppressor, is experiencing a new wave of interest after disappointing early trials. T8 cells, also known as Suppressor T-cells because they tend to put the lid on the immune response, are being drawn from patients, grown in a special device and re-injected into the original donor. Immunoglobulins are being administered intraveneously by some physicians in the hope of reducing the immune system's workload. Placental extracts are being injected because of the placenta's immunosuppressant properties during pregnancy. More importantly, physicians are stressing the importance of protecting oneself from infections that can last a lifetime, such as herpes, Epstein-Barr, CMV, syphilis, hepatitis C. These infections, most of which can be avoided by practicing safer sex, repeatedly stimulate an immune response and may hasten the progression of the disease by increasing virus production and exhausting the immune system.

The next time you hear about yet another immune booster which sends T-cells into orbit, remember that we need more research to determine whether it really is the proper strategy. If you decide to give it a try, be sure to have your physician follow the amount of active virus in your body (with tests such as p24 antigen, blood viremia). And don't forget that your immune system also deserves some rest!

(Stephan Korsia is Coordinator of Treatment Information and Education at APLA. He may be reached at 213.962.1600, ext 270.)

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