DANGER IN HYDROCORTISONE

Update 1988: We have not heard any news about hydrocortisone in some time. But the current consensus seems to be that small amounts used externally in ointments can be okay, when recommended by a physician.

Scientists are using hydrocortisone to stimulate the growth of the AIDS virus in the laboratory. They have published a warning that the drug may be harmful to HTLV-III positive persons. But the warning has failed to reach physicians, their patients, and support organizations.

Hydrocortisone, a steroid used to reduce inflammation, is sold over-the-counter in skin ointments. Doctors can prescribe larger doses, which can be given by injection. People should be on guard about prescribed use of hydrocortisone.

The warning appears in the paper, "Hydrocortisone and some other hormones enhance the expression of HTLV-III", by Markham, Salahuddin, Veren, Orndorff, and Gallo, published in the International Journal of Cancer, January 15, 1986. The researchers needed to grow the virus in order to develop a more effective test for it. Hydrocortisone significantly increased
the ability of the virus to infect human blood cells. Some other steroids also helped the AIDS virus (but to a smaller extent), and others had no effect.

The paper cites earlier studies in which similar steroids caused an increase in opportunistic infections and cancer.

There may be times when hydrocortisone can be justified even for persons exposed to the virus. Physicians must decide case by case. But it's important that the risk be known and that people think at least twice before using the drug at this time.

A new paper from the Albert Einstein College of Medicine reports important benefits from gamma globulin treatment of children with AIDS. An earlier study by the same group had already found the treatment clearly valuable for adults with pneumocystis.

Gamma globulin, a normal component of human blood, contains antibodies produced by the immune system. Doctors have routinely used it for years as a temporary boost for persons with certain immune-system deficiency (other than AIDS), or to prevent a contagious disease from developing after a normal person has been exposed to it. In the work reported here, gamma globulin
was used to prevent or treat secondary infections, not the underlying AIDS itself. During the three years of the latest study, most of the children in the control group deteriorated or died, while there were no deaths in the gamma-globulin treatment group. Since the study, however, eight of the fourteen children who received the treatment have died. We don't
know whether or not the gamma globulin had been discontinued.

Helper T-cell counts improved in 42 percent of the treatment group, compared to seven percent of the controls. There were far fewer cases of fever and of serious blood infections in the treatment group.

A new study will test hyperimmune globulin, which contains AIDS antibodies and might be more effective.

For more information, see the paper by Rubinstein and Calvelli in the May/June 1986 issue of Pediatric Infectious Diseases.

The earlier study (Silverman and Rubinstein, "Serum lactate dehydrogenase levels in adults and children with acquired immune deficiency syndrome (AIDS) and AIDS-related complex: possible indicator of B cell lymphoproliferation and disease activity; Effect of intravenous gamma globulin on enzyme levels", in The American Journal of Medicine, May 1985) reported on the
treatment of adults as well as children. One major finding was that gamma globulin was more effective than conventional treatments (trimethoprim/sulfamethoxazole and pentamidine) for pneumocystis. Of the adults with pneumocystis, all five in the control group died. Two of the four who received gamma globulin died after several months; we don't know if the treatment had
been continued. The other two were in stable condition with no evidence of pneumonia a year later, when the paper was written.

This work is important because gamma globulin is safe, very well known, and routinely available to doctors. In fact, the issue of the journal where this article appeared carried an advertisement filling three full pages for the same preparation used in the study. The ad listed "immunodeficiency" (but not AIDS) as the primary indication for its use. Gamma globulin
would seem to be an obvious choice to try against AIDS -- even before a leading authority on the disease (Dr. Arye Rubinstein) documented its use against pneumocystis a year ago. It could be used now and would almost certainly save lives, in the treatment of pneumocystis at least.

Yet practically nothing has been done. A computer search of over 4000 papers on AIDS turned up only nine which involved gamma globulin; of these nine, three were from the Albert Einstein group mentioned above, and three others only measured gamma globulin but did not administer it to patients. We know of only one report of failure to obtain benefit, and that study
involved just two patients.

Researchers may have overlooked this treatment because there were theoretical reasons to doubt its effectiveness. For instance, persons with AIDS have already very high levels of gamma globulin in their blood, even without any treatment. Perhaps the gamma globulin which is already there lacks some of the necessary antibodies. In any case, we hope that the new
report from the Albert Einstein College of Medicine will bring this promising therapy the attention which it deserves.