IPT AND THE TREATMENT OF HIV INFECTION: Clinical experience to date.
SGA, M.D., Donato Perez Garcia y Bellon, M.D., Donato Perez Garcia, Jr., M.D.
Unpublished article, 1987.
The two following cases represent our own pilot study to investigate the efficacy of IPT in the treatment of AIDS/ARC. Starting with the new cases that will be coming under treatment in Nexcio this month, we intend to standardize the gathering of clinical and laboratory information, so that this may be reported in a more organized fashion. Plans. have been made to have sera from all patients sent to Ortho Diagnostics of Newark, New Jersey, on a regular basis. Ortho will be performing initial immunologic evaluations as well as frequent follow-up determinations on all these patients. A periodic reporting on this clinical experience will be sent out to a number of investigators in the field of AIDS research.
This is the case of a 47 year old homosexual male with a diagnosis of AIDS-related-complex (ARC). The diagnosis had been established on the basis of clinical findings, two successive positive HTLV-III antibody determinations and a positive Western Blot assay for HTLV-Ill antibody. The serologic diagnosis was confirmed by the Centers for Disease Control in Atlanta. Having been apprised of the poor prognosis for his disease, this patient elected to undergo treatments with IPT. When he presented for consultation on November 25, 1986, the patient had complaints of a recurrent herpes zoster infection on the left side of his head and neck, painful cervical, axillary, and inguinal lyrnphadenopathy, fevers, malaise, weakness, diarrhea, headache, irritability, poor memory, depression and a weight loss of 15 kg (30 lbs) over the last 6-8 weeks. On physical examination, his BP was 140/60, temperature 370 C, weight 72 kg. Head and Neck: On the left side of the neck and over the left retroauricular area, there was a polymorphous dermatosis consisting of erythematous plaques with vessicles, pustules, nodules and crusts. On’ both sides of the neck there was a chain-like mass of nodes the largest of which measured approximately 2 cm. in diameter. These nodes produÈed a visible distortion on the sides of the neck, they were tender to palpation, and they caused a restriction of lateral movement in the neck. The rest of the examination of the head and neck was unremarkable. Chest:
Heart and lungs normal. There were multiple nodes palpable in each axilla with the largest being approximately 2 cm. Abdomen: No masses, tenderness or organomegaly. The patient had bilateral inguiÒil lymphadenopathy, with the largest lesions again measuring approximately 2 cm. Genitourinary:
Both testicles were tender, but the scrotal contents were not enlarged. The prostate was firm, slighty enlarged and tender. CNS: Cranial nerves intact; muscle power and coordination normal; sensory modalities of pain, light touch and vibration sense uniformly normal; ahomberg negative; deep tendon reflexes present and equal bilaterally.
The patient began a series of IPT treatments on’ November 27, and received these following medications:** Regular insulin 6u/IY. Oral:
Anistal (Silanes) (ranitidine hydrochloride 150mg) 1 tablet; Adiro (Bayer) (acetylsalicylic acid 500mg) 1 tablet; Benexol-B12 (Roche) (81-250mg, B2-250mg, B12-l000mcg) I tablet; Bentyl (Lepetit) (dicyclomine
hydrochloride 10mg) 1 capsule; Cholipin (Boeringer Ingelheim)
(1-phenyl-1-hydroxy-n-pentane 100mg, dimethyl-n-octyl(ethilic ester of
beta-bencilic acid) ammonium bromide 100mg) 1 tablet; Clinoril (MSD)
(sulindac 200mg) 1 tablet; Doryl (Merck) (carbamyl choline chloride 2mg) 1 tablet; Digenor (Rudefsa) (metclopramide hydrochloride 10mg, dimethicone 40mg) 1 capsule; Isoprinosine (Roussel) (Metisoprinol Soomg)
1 tablet; Lasix (Hoechst) (furosedmide 40mg) 1 tablet; Ripason (Knoll)
(liver extract 0.6gm) 1 tablet. Intramuscular: Glutatiol (Hormona) 0.5cc;
Iridus (Roussel) (“naftidrofurilo” acid oxalate 40mg/5cc) 0.3cc; Extracto
Higado (Lilly) (liver extarct 10cc) 0.5cc; Genoxal (Schering)
(cyclophosphamide 500mg/25cc) 0.2cc; Methotrexate (Lederle) (methotrexate
5Omg/2Occ) 0.2cc; Decadron (MSD) (dexamethasone 4mg/cc) 0.2cc; Baralgina
(Hoechst) 0.4cc; Voltaren (Geigy) (diclofenac sodium 75mg/3cc) 0.8cc.
Intravenous: Bilona (ICN Pharmaceutica) (Ribavirin 100 mg/cc) 0.3 cc; Cevalin (Lilly) (ascorbic acid lgm/lOcc) 1cc; Calcium (Sandoz) (calcium gluconate 1.375gm/lOcc) 0.5cc; Manibee-C (Endo) (Vitamin B-complex solution 10cc) 0.3cc; Carbecin (Sanfer) (carbenicillin disodium lgm/2cc) 0.4cc; Keflin (Lilly) (cephalothin sodium 1gm/icc) 0.4cc. These intravenous medications were given mixed with 50% hypertonic glucose solution. In this way, the patient received a total of 50 cc of the glucose solution with each treatment. Betwen his weekly treatments, as interim therapy the patient took Bilona (ribavirin) 200mg orally, once a day.
Coincident with the patients undergoing these treatments, his clinical situation became much improved. His diarrkea lessened greatly following the first treatment. By the third it had disappeared completely, as had the fevers, headaches, poor memory and depression. The patient reports feeling well in all repects, and has resumed his normal
activities of daily living. On examination, the herpes zoster erruption is no longer in evidence and there have been no recurrences of it to date. The swellings in his neck are no longer visible, and there is no palpable lymphadenopathy in the neck, axillae or inguinal regions. He has, full movements of his neck, and he has gained 15 lbs. By June 9, 1987, the patient had undergone a total of 10 treatments and remains in a good state of health. On March 4, 1987, a repeat HTLV-III assay (Elisa) was done and reported as positive, the total T4 lymphocyte count was 233 (normal: >400), and the T4:T8 ratio was 0.45 (normal: >0.9). The patient remains under active treatment with regularly scheduled follow-up laboratory testing.
This is the case of a 22 year old Mexican homosexual male who was found to be HIV positive and developed signs of encephalopathy with severe, debilitating dementia. The patient underwent IPT treatments for 4 months in Mexico City. During this course of treatment, all signs of the patient’s presumed intra-CNS HIV infection resolved completely with a full return of normal function, physical and mental. It is reported that two follow-up HIV antibody tests (Elisa) were performed in Mexico City, and that these tests were negative on both occasions. No other testing has been done. Because of the full recovery from his clinical situation, this patient feels that continuing treatment and testing is unnecessary, and, as of June 1, 1987, he has been lost to further follow-up.