DNCB AIDS/ARC Treatment

There's more to DNCB than meets the eye. This writer had ignored the story, because it appeared confusing and not very important. But patients using DNCB persuaded me to take a closer look - and a very different picture emerged.

Researchers have not completed rigorous clinical studies of DNCB, so we don't have definitive scientific proof of its effectiveness. But the evidence we do have clearly places DNCB among the most hopeful treatment possibilities currently available. And the ongoing work with DNCB is providing new insights into AIDS, and into the differing treatment needs of
different classes of patients.

DNCB is other stories, too. The lack of institutional DNCB research has led to a network of "guerrilla clinics", now in 14 U.S. cities and growing almost daily. These groups are supplying each other with batches of DNCB lotion and instructions for use, on the condition that the lotion never be sold but always given away free.

The dangers may be small, but doctors are concerned at the lack of scientific testing and of medical supervision. And yet, for most people, the guerrilla clinics will remain the only alternative - until institutional science and medicine gives this treatment the attention it deserves. (At this time we know of physicians using DNCB in only five cities: San
Francisco, Berkeley, Los Angeles, San Diego, and New York.)

A Brief History

DNCB (dinitrochlorobenzene) is a chemical that affects the body much like poison oak. It penetrates the skin and binds onto protein there, rendering these proteins much more likely to stimulate an immune reaction. In a person who has normal immunity, DNCB causes a rash like poison oak. The pure chemical is so strong that it must be diluted almost a thousand
times before use.

Immunologists have used DNCB extensively in their research. Several years ago, Dr. L. Bruce Mills - then a Stanford research dermatologist studying the biochemistry of certain enzymes - observed that DNCB successfully treated a kind of severe warts, in children, that could not be effectively treated conventionally. Not only did the treated warts disappear, but all the other warts on the body, too. It
turned out that the DNCB stimulated the development of T-cells, correcting the immune defect which had allowed the warts to develop. The DNCB treatment - for certain kinds of warts - has become generally recognized as effective.

Next, Dr. Mills, now a physician in private practice in San Francisco, tried DNCB for treatment of KS lesions in persons with AIDS. Not surprisingly, it turned out that KS was more difficult to treat than the warts. But there were dramatic improvements in many cases, and not only for KS. Recently, Dr. Mills has distinguished four groups of AIDS/ARC patients. Different treatments are
appropriate to the different groups.

The Autoimmune Theory of AIDS/ARC

Before describing the four groups of patients, it is important to outline a new theory of AIDS now being developed by a number of researchers, including Dr. Mills.

In the conventional theory, the AIDS virus (formerly called HTLV- III, or LAV, now named Human Immunodeficiency Virus, or HIV) infects the T-cells, especially the T4, or helper T-cells, that control the immune system. The helper T-cells normally recognize foreign proteins, and instruct the B cells (a different part of the immune system) to produce specific antibodies which attack the invading
organisms.

In AIDS, the virus kills most of the helper T-cells, so the immune system cannot identify the disease-causing organism. The B cells do generate lots of antibodies, but they are the wrong ones. Therefore, the body cannot resist certain opportunistic infections and cancers which, normally, it could easily control.

New T-cells are being produced all the time, at least until the person is gravely ill. But, according to the conventional theory of AIDS, the virus keeps killing them.

The autoimmune theory accepts all of the conventional view outlined above. But it also says that a different mechanism can keep killing the T-cells, even if the virus is no longer a problem in some patients.

This theory states that the high level of wrong antibodies produced by the B cells can begin attacking normal body cells, especially the T-cells themselves. The result is a vicious circle - with the T-cells unable to control the B cells, and the B cells producing antibodies which in turn kill T-cells. Many separate observations support the autoimmune theory: for example, the recent
discovery of a new kind of anti-platelet antibody that is specific to AIDS/ARC patients.

The Four Groups of Patients

Dr. Mills' patients not only receive DNCB; they also receive extensive monthly laboratory blood tests, whenever financially possible. The resulting data has led Dr. Mills to the following classification of patients:

The first question asked when he groups AIDS/ARC patients is whether the level of gamma globulin (immune globulins) is extremely high, close to 3000 or worse. If so, there is a problem from too much antibodies. Dr. Mills calls these patients Group III (discussed below).

Group I patients get the most dramatic benefit from DNCB. Their immune globulin level is not too high, and these patients respond well to DNCB in three to six months - in laboratory tests and by clinical improvement. These patients may not need any other treatment than DNCB.

Note that it does take time to get results, however. That is because DNCB works by stimulating the growth of new T-cells, and it takes time for these cells to be produced and to mature.

Group II patients also have a reasonable immune globulin level, but they do not respond well to DNCB in three to six months. Dr. Mills believes these patients may also need an antiviral.

Group III, mentioned above, has the problem of too much antibodies. For these patients, many of the other lab results are unreliable. Dr. Mills hopes that about a year of treatment with DNCB can reduce the immune globulin level.

Group IV is end-stage AIDS. DNCB may raise the T-cell counts a little, but it is too late to save the person's life. Note that Mills' classification is different from the normal distinction of ARC vs. AIDS, and that many patients with pneumocystis or KS (for whom most doctors have all but given up) would not be in group IV, but in one of the other three groups.

How is DNCB Used?

Usually, a small amount of DNCB (2/15 of one percent) is dissolved in Vaseline Intensive-Care lotion. Sometimes other solutions are used. Once a week, the doctor paints a small patch on the arm, covers it with gauze, and tells the patient to remove the gauze and wash off the DNCB lotion in a certain number of hours. The DNCB should cause a rash to appear on the skin. Patients with a suppressed immune system will not react at first, but everyone tested
so far has eventually achieved a reaction.

In KS conditions, the DNCB is painted directly on the KS lesions, but usually only after a skin reaction has already been achieved on the arm.

Dr. Mills also has patients take about a dozen blood tests. These include T-cell subsets, immune globulins, lymphocytes, and platelets. Also included are blood lipids, liver function, and other tests to warn of any dangerous side effects of the DNCB; so far, none has been found. In addition, he runs standard tests for rheumatoid arthritis, lupus, and syphilis, even though the patients do not have
these conditions, because positive results may indicate a malfunctioning immune system.

A Case History

We spoke with one patient - not referred to us by Dr. Mills - who is considered a star patient, because there are no complicating factors in his case. He started treatment early, while severely immune suppressed but not otherwise ill. He took no other treatments and had no opportunistic infections or other illnesses during the treatment. He received extensive lab work on several occasions, so
there is much data available to study. And he continued the DNCB treatments without interruption in the ten months he has been Dr. Mills' patient.

When he began treatment, his helper/suppressor ratio was .22, and absolute helpers 118. At that time, he read an article that claimed that it was impossible to reconstitute the immune system if the helper number was less than about 245.

For the first five months, the number went up, but just a little: 118, 265, 295, 365. At that time he was discouraged and had no further tests done for four months, but he continued the DNCB. When retested, in June 1986, the helpers were 529, (within the normal range of 447-1284). This month (September) they rose to 707. Total T-cells went from 686 at the beginning, to 2259. The helper/suppressor ratio had climbed from .22 to .63 - not yet normal, but a major improvement.

Meanwhile, all the other lab tests moved in the right direction (or stayed normal). Immune globulins decreased from 2600 to 1830 (normal range is 540-1480). Lymphocytes increased from 1400 to 2700 (normal is 800-3200). Hemoglobin improved from 12.7 to 15.3 (normal is 13.9-18). The lupus and rheumatoid arthritis tests went from positive to normal; the "syphilis" antibodies dropped.

The patient told us that Dr. Mills believes that it may eventually be possible to stop using the DNCB, but he isn't sure yet.

Despite these results, the patient is unsure how many others will have the persistence to follow the treatment consistently, even though the results are slight for the first several months. When he started DNCB, he was feeling well; he had only a positive antibody test. Fortunately, he then took the T-cell subset lab test, which showed that though he was feeling well, he was living on borrowed time; it is
surprising that he had not already developed pneumocystis or other problems. He began the DNCB treatment immediately and stayed with it.

Since this patient was well throughout, there was no opportunity to observe clinical improvement. Many others have shown major clinical improvement, including a resolution of nailbed fungal infections, KS lesions (even severe ones) that have almost disappeared, and generally feeling better and having more energy.

What's Needed Now?

The above case history, and the 26 others summarized by Dr. Mills in his letter published in the June 1986 Journal of the American Academy of Dermatology, are not scientifically conclusive. The reason is that patients in a private practice are self selecting. Those who don't think the treatment is working usually leave, so that only the good results tend to be reported. We need well-designed, controlled
clinical studies to prove the effectiveness of DNCB, and to provide further information on exactly how to use it most effectively.

We have heard reports that such studies are now beginning in New York and Los Angeles, but have not been able to investigate these reports by press time.

In San Francisco, Dr. William L. Epstein, Chairman Emeritus of the Department of Dermatology at U.C. Medical Center, wants to perform a study of DNCB (and also urushiol, the active ingredient of poison oak) for AIDS as well as other immune diseases. Dr. Epstein is President of the American Academy of Dermatology and the world's foremost expert on contact skin sensitization (such as caused by
poison oak or DNCB). But, so far, the study has not been approved. The rumor we have heard - not from Dr. Mills, nor from Dr. Epstein, who was not contacted for this story - is that the study was first denied funding, and then also denied permission to use patients; and that the reason the study was prohibited was rooted in the politics of personal and professional rivalries, including the fact that cancer
specialists - not immunologists - have held political control of AIDS research.

Any physicians interested in studying or using DNCB for AIDS or ARC should note that, as far as we know, there have never been harmful effects from such use, except that with occasional patients the expected skin reaction can be severe. Dr. Mills does not know of any kind of AIDS/ARC patients who should NOT get DNCB, although clearly it will help some groups of patients more than others. DNCB is already
used in medical practice, and a pharmacy can mix it for use. The cost is negligible. Application requires only a Q-tip, once a week, plus ordering standard laboratory tests. In short, there are no technical bstacles to wider use of DNCB, nor to conducting the kinds of studies needed to get definitive answers on its value for AIDS or ARC.


For More Information

Published information can be found in the June 1986 Journal of the American Academy of Dermatology, pages 1089-1090. Also, see Michael Helquist's articles in Coming Up! (October 1985), and in The Advocate (November 12, 1985, April 4, 1986, and November 25, 1986), and Pat Christen's article in the Bay Area Reporter (June 19, 1986). Ann Guidici Fettner has a short article in the New York Native (June
23, 1986). Also see "Autoimmune Drug Discovery Published", in Update, June 11, 1986.

Most physicians are not set up to handle large numbers of calls, and they can seldom return calls except from their patients or from other physicians.

The best person to call for information about DNCB and the guerrilla clinics is Jim Henry, at (415) 647-8561. He can tell you whom to contact near your area about using DNCB.

Another information source is the Project Inform hotline (800- 334-7422 within California; 800-822-7422 from other states). Project Inform is primarily interested in ribavirin, but is also aware of DNCB, as the two treatments might complement each other.