REPLY
Host-Directed Therapy for AIDS
Michael M. Lederman, MD
15 September 1995 | Volume 123 Issue 6 | Page 472
IN RESPONSE:
Stricker and Goldberg suggest that DNCB is used by thousands of HIV-infected patients around the world at a cost of pennies a week [1]. Although the cash outlay for DNCB is modest, the actual cost of this therapy may be substantially greater. The clinical value of DNCB is currently uncertain. Several uncontrolled studies have suggested that some patients treated with DNCB may experience increases in the number of circulating CD8+ lymphocytes; in some instances, increases in the number of CD56+ lymphocytes (cells with a natural killer phenotype) were also seen [2, 3]. These observations must be confirmed by carefully controlled trials; moreover, the significance of these laboratory findings must be correlated with indices or evidence of clinical benefit.
Broad use of unproven therapies outside of controlled clinical trials can result in misinterpretation of potentially biased results, such as the contention that patients compliant with DNCB do better than those who are noncompliant[3]. A second cost of widespread use of unproven therapies is the potential loss of access to established therapies if patients mistakenly believe they are receiving a therapy of confirmed benefit.
Although I cannot speak for the medical community, I suspect that the results of a well-controlled trial of DNCB would be received with great interest. Widespread use of DNCB outside of clinical trials, however, should not be encouraged.
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Author and Article Information
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Case Western Reserve University; Cleveland, OH 44106
1. Stricker RB, Elswood BF, Goldberg B, Henry J, et al. Clinical and immunologic monitoring of HIV-infected patients treated with topical dinitrochlorobenzene (DNCB) [Abstract]. Int Conf AIDS. 1994; 10:216.
2. Traub A. Use of DNCB as an immune modulator in HIV-positive patients-a pilot study [Abstract]. Int Conf AIDS. 1994; 10:219.
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