TOPICAL IMMUNE MODULATION WITH DINITROCHLOROBENZENE IN HIV DISEASE - A CONTROLLED TRIAL FROM BRAZIL

Objective: Despite the rapid spread of human immunodeficiency virus (H IV) in the developing countries of Africa, Asia and Latin America, acc essible and affordable antiretroviral therapies have not been develope d. Dinitrochlorobenzene (DNCB) is an inexpensive contact sensitizing a gent 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. Design and Methods: Thirty-five HIV-infected subjects were divided in to a control group that refused DNCB therapy (6 patients) and a treatm ent group that applied topical DNCB on a weekly basis throughout the s tudy (29 patients). Subjects were monitored for adverse clinical event s, progression to AIDS and changes in body weight. CD4 and CD8 T-cell counts were also monitored in both groups. Results: Control and treate d patients were evenly matched in terms of age, initial clinical statu s and prior adverse clinical events. The mean follow-up was 19.7 month s for the control group and 17.8 months for the DNCB group. Control pa tients 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 in creased (p<0.001), CD4 and CD8 T-cell counts decreased significantly i n the control group and increased in the DNCB group (p<0.001 and p=0.0 31, respectively). DNCB therapy was well tolerated. Conclusions: Topic al DNCB therapy affords a rational, effective and inexpensive treatmen t approach for HIV disease. DNCB should benefit patients in developing nations with limited access to health care.