WHOLE-BODY HYPERTHERMIA IN THE TREATMENT OF AIDS-ASSOCIATED DISSEMINATED KAPOSIS-SARCOMA - A REVIEW

The manifestation of illness in those persons infected with HIV may re flect disruption of immune regulation and not direct viral killing. Si gnificant disruption of steroid hormone production has been described. Antiretroviral use is not associated with survival advantage and does not restore homeostasis. We report studies on long-term survivors of systemic Kaposi's sarcoma (Waiter Reed stages 3-4) following a single session of whole body hyperthermia (to 42 degrees C) by extracorporeal perfusion (and no use of antiretrovirals). Semiquantitative PCR deter minations in all patients treated demonstrated di-minution in viral lo ad following whole body hyperthermia. Augmentation of CD8 and NK cells was noted. In some patients this is associated with a fall in CD4 cel ls as inappropriate immune activation is corrected. Of the cohort of 3 1 patients now followed for 4 years, 8 remain alive. (Survival data: a t 4 months, 29 alive [20 expected]; at 12 months, 21 alive [13 expecte d]; at 24 months, 16 alive [6 expected]; at 36 months, 8 alive [0 expe cted]). Clinical benefit reached a plateau in half the patients at six months. Four of the 31 achieved long-term remission of both KS and HI V (by PCR determination). This was associated with the presence of a l ow grade graft versus virus reaction. There is a survival advantage fo r whole body hyperthermia in this illness. The results were confirmed in 10 additional patients treated with whole body hyperthermia by infr ared radiation. All patients with hepatitis C cleared infection as wel l (as determined by RNA analysis). Augmentation of clinical (and cellu lar responses) has been demonstrated with use of interferon-alpha at t he time of hyperthermia; antioxidant supplementation following hyperth ermia; ex vivo activation of Th1 cells with return to the patient and modulation with dehydroepiandrosterone and specific cytokine.