Topical immune modulation with dinitrochlorobenzene in HIV disease: a controlled trial from Brazil.
OBJECTIVE
Despite the rapid spread of human immunodeficiency virus (HIV) in the developing countries of Africa, Asia and Latin America, accessible and affordable antiretroviral therapies have not been developed. Dinitrochlorobenzene (DNCB) is an inexpensive contact sensitizing agent that stimulates cell-mediated immunity when applied to the skin. We have examined the clinical and immunologic effects of topical DNCB therapy in a cohort of indigent patients with HIV disease from Brazil.


METHODS
Thirty-five HIV-infected subjects were divided into a control group that refused DNCB therapy (6 patients) and a treatment group that applied topical DNCB on a weekly basis throughout the study (29 patients). Subjects were monitored for adverse clinical events, progression to AIDS and changes in body weight. CD4 and CD8 T-cell counts were also monitored in both groups.


RESULTS
Control and treated patients were evenly matched in terms of age, initial clinical status and prior adverse clinical events. The mean follow-up was 19.7 months for the control group and 17.8 months for the DNCB group. Control patients had significantly more adverse clinical events and progression to AIDS during the study than the treatment group (p = 0.002 and p = 0.013, respectively). There were no deaths in either group. Control patient weights decreased over the study period while DNCB patient weights increased (p < 0.001). CD4 and CD8 T-cell counts decreased significantly in the control group and increased in the DNCB group (p < 0.001 and p = 0.031, respectively). DNCB therapy was well tolerated.


CONCLUSIONS
Topical DNCB therapy affords a rational, effective and inexpensive treatment approach for HIV disease. DNCB should benefit patients in developing nations with limited access to health care.
Traub
A
A
Sexually Transmitted Disease Unit, Irmandade da Santa Casa de Misericordia, Porto Alegre, Brazil.
Margulis
S B
SB
Stricker
R B
RB
D000163:Acquired Immunodeficiency Syndrome / Q000503:physiopathology; D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000279:Administration, Cutaneous; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001835:Body Weight; D001938:Brazil; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003906:Developing Countries; D004137:Dinitrochlorobenzene / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D018450:Disease Progression; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000503:physiopathology / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007167:Immunotherapy / Q000191:economics; D007509:Irritants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D018655:Lymphocyte Count; D008297:Male; D008489:Medical Indigency
D000276:Adjuvants, Immunologic; D019380:Anti-HIV Agents; D004137:Dinitrochlorobenzene; D007509:Irritants