TO THE EDITOR:
The article by Blatt and colleagues [1] shows the prognostic significance of cutaneous delayed-type hypersensitivity testing in patients infected with human immunodeficiency virus (HIV). The excellent editorial by Kornbluth and McCutchan [2] discusses the Th1/Th2 switch that plays an important role in the loss of delayed-type hypersensitivity in HIV. Both articles focus on delayed-type hypersensitivity as a diagnostic tool in patients with the acquired immunodeficiency syndrome (AIDS).
The concept of using the cutaneous delayed-type hypersensitivity response as a therapeutic tool in patients with HIV has been discussed previously [3]. Topical dinitrochlorobenzene, a potent stimulant of the delayed-type hypersensitivity response, was suggested as treatment for AIDS in 1986. Since that time, long-term use of dinitrochlorobenzene by patients infected with HIV has been reported [4], and a pilot study of topical dinitrochlorobenzene treatment has been done [5]. The theory underlying dinitrochlorobenzene use in patients with AIDS is that stimulation of cutaneous delayed-type hypersensitivity reverses the functional loss of antigen presentation that occurs during the course of the disease [3, 5]. This effect in turn reverses the Th1/Th2 switch responsible for anergy in patients infected with HIV, with consequent boosting of the cellular immune response against the virus [6].
It is time to think of cutaneous delayed-type hypersensitivity not just as a diagnostic tool but rather as the gateway to the immune system in patients with AIDS.
1. Blatt SP, Hendrix CW, Butzin CA, Freeman TM, Ward WW, Hensley RE, et al. Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. Ann Intern Med. 1993; 119: 177-84.
2. Kornbluth RS, McCutchan JA. Skin test responses as predictors of tuberculous infection and of progression in HIV-infected patients. Ann Intern Med. 1993; 119:241-3.
3. Stricker RB, Elswood BF, Abrams DI. Dendritic cells and dinitrochlorobenzene (DNCB): a new treatment approach to AIDS. Immunol Lett. 1991; 29:191-6.
4. Stricker RB, Elswood BF. Topical dinitrochlorobenzene in HIV disease. J Am Acad Dermatol. 1993; 28:796-7.
5. Stricker RB, Zhu YS, Elswood BF, Dumlao C, Van Elk J, Berger TG, et al. Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection. Immunol Lett. 1993; 36:1-6.
6. Cumberbatch M, Gould SJ, Peters SW, Basketter DA, Dearman RJ, Kimber I. Langerhans cells, antigen presentation, and the diversity of responses to chemical allergens. J Invest Dermatol. 1992; 99:107S- 8S.
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