Extracorporeal photopheresis in the treatment of AIDS-related complex: a pilot study

Article Abstract:

Acquired immunodeficiency syndrome (AIDS), which is caused by infection with the human immunodeficiency virus (HIV), impairs the immune system and leads to life-threatening infections. Specifically, HIV attacks a type of blood cell called a T-helper lymphocyte, which normally stimulates the immune system to fight off infections. AIDS patients typically suffer from an enlargement of the lymph nodes (lymphadenopathy) which often occurs prior to infection. This report describes the possible beneficial effects of extracorporeal photopheresis used in five patients with AIDS-related complex (ARC). In this procedure, patients are given a photosensitizing drug called 8-methoxypsoralen, which is taken up by all body cells including those infected with HIV. The patient's blood is then withdrawn, exposed to long-wave ultraviolet light, and reinfused into the body. Upon exposure to the light, a chemical reaction occurs in the virally infected cells that results in death of the cells. The lymphadenopathy disappeared in all five patients and tests revealed an increased functioning of the patients' immune systems. Blood samples from three of the five patients revealed an absence of HIV, but further research is needed to ascertain whether this is a long-term effect. It is important to note that this study included a small number of subjects and failed to compare them with a control group; thus the results can only be considered preliminary. However, photopheresis is an effective treatment for other types of viral infections and may prove beneficial in the treatment of HIV infection. It is concluded that extracorporeal photopheresis should be studied further as a treatment for HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Photopheresis and human immunodeficiency virus (HIV) infection: the Annals views preliminary reports

Article Abstract:

The acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV), impairs the body's immune system and inevitably leads to life-threatening infections. AIDS patients usually have a swelling of the lymph nodes of the body (lymphadenopathy) and also produce antibodies against HIV. Antibodies are proteins produced by the immune system that bind to and inactivate foreign substances. A report in the August 15, 1990 issue of the Annals of Internal Medicine describes a possible beneficial effect of extracorporeal photopheresis in patients with AIDS-related complex (ARC). In this procedure, patients are given a photosensitizing drug called 8-methoxypsoralen that makes virally infected cells sensitive to long-wave ultraviolet light (UV). The patient's blood is withdrawn through a tube, exposed to the UV light, and then reinfused. The lymphadenopathy disappeared in all five patients and their immune systems became more functional. No toxicity from this treatment was observed, but due to the way the study was conducted it cannot be concluded that the course of the disease was modified or that long-term survival was increased. Only five patients were studied and the experiment was not conducted in the usual manner used to assess the effectiveness of drugs. Clearly, further research is needed to assess the effectiveness of photopheretic therapy in ARC patients; larger numbers of patients should be tested using standard research methodology. This editorial discusses the decision by the journal to publish this study despite its shortcomings in methodology. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Extracorporeal photopheresis in the treatment of AIDS-related complex: extended trial

Article Abstract:

Treatment of AIDS-related complex with photopheresis appears to be safe and should be studied further. In human photopheresis, which is also known as photoimmunotherapy, psoralen is taken orally and is inactive until exposure to ultraviolet light. Previous laboratory studies have found that photopheresis inactivates HIV. Nineteen HIV-positive patients began monthly treatment with photopheresis. Clinical stability of the disease was seen in 16 of the patients. In terms of disease stage, 11 of the patients improved, seven remained the same and two worsened. Overall, well-being and fitness improved in 18 patients. Furthermore, photopheresis therapy, unlike treatment with the drug zidovudine, does not appear to adversely affect the immune system's ability to respond.

Evaluation, Photochemotherapy

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