C94882SM%WUVMD.BITNET@oac.ucla.edu (Steve Middlebrook) (06/08/90)
I called the Atlanta Hospital and asked about the hyperthermia treatment.
Attached is a transcript of the info the faxed me. It includes a press
release and "draft pre-publication clinical study." The study includes
reference numbers in parentheses, but had no bibliography attached.
Please pardon any typos.
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May 31, 1990
PRESS RELEASE
At Atlanta Hospital, on February 20, 1990, 705 Juniper Street, NE, Atlanta,
Georgia, 30365, Physicians performed the first known treatment of Kaposi's
Sarcoma, in an HIV positive patient, by total body hyperthermia (extra
corporeal heating via heat exchanger to 42 degrees C for two hours). The
patient tolerated the procedure well and was released from the hospital after
three days with a negative HIV culture. The Patient has maintained a
negative HIV culture for over 90 days and has resumed normal activities of
daily living. The initial clinical study and associated laboratory data would
seem to indicate that prolonged heat exposure may have an inhibitory effect
on HIV replications. Further studies are in progress. For further
information, please contact:
William D. Logan, Jr. M.D.
Kenneth Alonso, M.D.
Foundation for Virology & Oncology
340 Boulevard Ave., N.E.
Suite 134
Atlanta, GA 30312
(404) 577-5720
or
Atlanta Hospital
(404) 873-2871, extension 310 or 399
DRAFT PUBLICATION
Abstract:
The effect of prolonged exposure to heat on the HIV has had limited
exploration. This is the report of a 33yo white man with positive tests for HIV
and multiple lesions of Kaposi's Sarcoma. The patient was exposed to total
body hyperthermia of 42 degrees C for two ours. Three months following
hyperthermia the patient feels improved. The lesions of Kaposi's Sarcoma
have markedly regressed, and the T4 lymphocyte count has risen from 5/cc to
330/cc. HIV cultures (blood) remain negative. These data would indicate this
modality of therapy has altered the progression of disease in this patient.
Total Body Hyperthermia in the Treatment of Kaposi's Sarcoma in an HIV
Positive Patient
Total Body Hyperthermia in the Treatment of Kaposi's Sarcoma in an HIV
Positive Patient
W. D. Logan, Jr., M.D. FACS, and K. Alonso, M.D., FACP
Therapeutic strategies for the treatment of HIV related disease have been
reviewed recently (1). Hyperthermia has long been studied in oncology.
Stimulation of immunologic surveillance as well as recovery of some
immunologic function has been reported with its use (2).
The effect of prolonged exposure to heat on the HIV itself has had only
limited exploration (3,4). Data are conflicting depending on cell line
employed. This is a case report of the effect of systemic heat exposure to the
HIV itself as well as to HIV related disease (Kaposi's Sarcoma).
The patient studied is a thirty-three year old white male who presented with
rectal pain in October of 1989. There was a history of generalized malaise with
poor eating habits for several months. he also gave a history of recent onset
of small lesions occuring on the upper trunk and face.
Generalized lymphadenopathy was noted with several small, red, crusted,
irregular skin lesions on the face and upper trunk; measuring 6-10 mm in
greatest diameter. There was one raised, fungating, crusted lesion at the anus
measuring 1 by 2 cm in size.
Laboratory studies revealed FTA to be positive; a Chlamydial Titer was 1:64.
Protein electrophoresis was unremarkable. The Western Blot demonstrated
the presence of p24, gp41, and gp160. T4 Lymphocytes were determined at 5
per cc.
Biopsies of the rectal lesion and a skin lesion were reported as compatible
with Kaposi's Sarcoma. The cervical lymph node biopsy revealed non-
specific inflammatory change.
He was started on full dose AZT. The skin lesions and adenopathy did not
regress. After several weeks Interferon-a2 was added along with the full dose
AZT. The patient continued symptomatically unimproved with some
worsening of general symptoms. In January 1990, more extensive skin
lesions were noted on the face, scalp, trunk, base of tongue and anus. Some of
these lesions measured up to 5 cm in diameter. Repeat protein
electrophoresis demonstrated a polyclonal gammopathy, T4 Lymphocytes
were 50 per cc; blast transformation remained impaired.
A Kaposi's skin lesion was obtained and grown in tissue culture with
response to heat exposure determined (4). After exposure to 42 degrees C for
one there was a greater than fifty percent reduction in tumor growth as well
as reverse transcriptase levels in the culture supernatant compared with pre-
heat levels.
The case was then presented to the Atlanta Hospital Institutional Review
Board as a patient who was worsening with full AZT and Interferon-a2
therapy. After approval of the board and permission from the patient,
systemic hyperthermia was undertaken.
On Feb. 20, 1990, at Atlanta Hospital, the patient was taken to the operating
room. Under general anesthesia the right femoral artery and vein were
cannulated and connected for extracorporeal heating via heat exchanger.
Temperatures in the heat exchanger were raised gradually and maintained for
the desired cor temperature. Thermometers in the pulmonary artery and in
the bladder monitored the cor temperature, which was ultimately maintained
at 42 degrees C (within .2C) for two hours. Cooling took place gradually for a
thirty minute period. The patient tolerated the procedure well and was alert
within several hours. He was discharged from the hospital on the third
postoperative day.
It was noted during the hyperthermia the Kaposi's Sarcoma Lesions were
intensely erythemic with a bright red RhaloS around the lesions. The
erythema subsided over the next twelve hours. The lesions began to crust
and regress within 48 hours post-hyperthermia. AZT was not restarted. At
seven days postoperatively some lesions were noted to be reduced more than
fifty percent of the original size. The tongue and rectal lesions have
disappeared. Interlukin-2 levels peaked at 33 units/ms and fell to 19 units/ml
within 24 hours after hyperthermia. Preoperative interferon levels were less
than 10 units/ml and were not raised with hyperthermia. Total lymphocyte
count rose within 24 hours from 0.4 to 1.4 thousand with 105 T4 lymphocytes
per cc noted. Blast transformation was no longer impaired as measured by
PHA stimulation. Reverse transcriptase levels of blood had fallen by 70
percent.
At six weeks post-hyperthermia, the patient showed maximum skin lesion
regression. His overall general feeling has markedly improved and the
lymphadenopathy has regressed. Total T4 cells were up to 330 per cc and the
HIV culture was reported as negative. HIV cultures remain negative at 3
months.
These clinical findings and laboratory data would seem to indicate that
prolonged heat exposure may have an inhibitory effect on HIV replications.
Further studies are in progress.
Acknowledgements:
Edgar Grady M.D. FACS originally treated patient and referred for
hyperthermia.
Joseph Gussman -- Perfusionist.