HYPERTHERMIA REPORT: ONLY ONE PATIENT

In the last week of May, CNN television and other media
reported a single case of a patient with AIDS and Kaposi's
sarcoma (KS), who seemed to be much improved after hyperthermia,
a treatment which consists of artificially raising the body
temperature. Hyperthermia was previously used for treating
certain infections, such as syphilis, and is still used in some
advanced cases of cancer.

According to a brief written report by doctors Kenneth
Alonso and William D. Logan Jr. of the Atlanta Heart and Lung
Clinic at Atlanta Hospital, the patient had worsening KS and a
T-helper count of 50 before beginning the treatment. AZT and
alpha interferon had not prevented the symptoms from worsening.

Institutional Review Board gave permission to try
hyperthermia.

Using tubes inserted in an artery and a vein in the thigh,
blood was withdrawn, heated outside the body with a heat
exchanger, and then put back into the circulation. With
temperature carefully monitored by thermometers in the pulmonary
artery and in the bladder, body temperature was gradually raised
to 42 degrees C (between 107 and 108 degrees F) for two hours.
The patient, who was under general anesthesia, was then cooled
gradually.

Lesions started to improve within 48 hours, and by seven
days some were less than half of their original size. Maximum
improvement had occurred at six weeks; some but not all of the
lesions had disappeared. The patient's T-helper count had
increased from 50 to 330. HIV cultures were negative (which may
mean little, however, because of the unreliability of most viral
cultures), and reverse transcriptase in the blood (a measure of
viral activity) had fallen by 70 percent.

The physicians submitted a report of this case for
publication in a medical journal. When the story got into the
press, they insisted that the treatment was not a cure. But some
of the press reports suggested that despite the doctors' caution,
the patient believed he was cured. Extensive coverage has led to
hundreds of phone calls to the physicians and to AIDS service
organizations.

Comment

It is hard to evaluate this report without detailed peer
review. Most AIDS experts reached by reporters have been
reluctant to say much on the record until they know more. Most
do seem to agree that the treatment might be useful, and that it
must be investigated further.

Why would a report of a single case lead to national
publicity? May is a "sweeps" month, when the audiences of TV
stations are carefully measured in order to set advertising
rates, and when, therefore, the stations do everything possible
to boost their audiences. One media expert speculated that if
the report had arrived a few days later, in June, it would not
have been a story.

It is unfortunate when widespread reporting raises hopes
prematurely. But in this case the publicity may also have made
an important contribution. Despite the widespread agreement that
the treatment might be useful and should be investigated, there
is a serious risk that no followup trial will be organized.
Hyperthermia has little commercial potential, since it generates
only one sale of a relatively simple and inexpensive machine to
each center which uses it; it does not lead to repeat sales, as
pharmaceuticals do. Hyperthermia has no constituency in the
government or in any part of the AIDS research establishment.
Hopefully the widespread publicity will generate enough interest
so that someone will follow up with a small trial.

Hyperthermia is dangerous if done improperly; it must be
performed by knowledgeable physicians. Published articles on
this technique describe extensive precautions which are taken for
the patient's safety. If formal studies are not conducted, the
treatment may instead come into use in the offices or clinics of
physicians not trained to employ it properly. Fortunately, the
procedure tried in one case with AIDS is exactly the same as that
often used in treating cancer, meaning that the technology, staff
training, precautions, risk estimates, etc. are already in place.

As far as we know, the patient in Atlanta is the only person
with AIDS who has been treated with hyperthermia. The idea had
previously been suggested; see References, below.

For More Information

For more information, physicians can write to Dr. Kenneth
Alonso, 203-B Medical Way, Riverdale, GA 30274, phone 404/991-
1971.

Note: In a completely separate effort, Dr. Shawn Hankins, a
chiropractor in Port Angeles, Washington, has been urging a test
of hyperthermia since July, 1987. He points out that HIV is heat
sensitive, and in addition, hyperthermia can cause increased T-
cell proliferation, phagocytosis, and increased production of
antibodies and interferon. Anecdotal observation, such as the
"honeymoon effect" that sometimes follows pneumocystis (which
causes a high fever) also supports this possibility. Dr. Hankins
can be reached at 616 E. Front St., Port Angeles, WA 98362.

References

Brenner, S. HIV appears to have some susceptibility to heat
[letter]. AIDS Research and Human Retroviruses, volume 5 number
1, pages 5-6, February 1989.

Bull, JM. A review of systemic hyperthermia. Front. Radiat.
Ther. Onc., volume 18, pages 171-176, 1984.

Weatherburn, H. Hyperthermia and AIDS treatment [letter]. The
British Journal of Radiology, volume 61 number 729, pages 863-
864, September 1988.

Yatvin, Milton B. An approach to AIDS therapy using hyperthermia
and membrane modification. Medical Hypotheses, volume 27, pages
163-165, 1988.

News Flash Alonso to speak: Dr. Alonso is scheduled to speak
about the hyperthermia treatment at the "alternative" AIDS
conference in San Francisco, the Advanced Immune Discoveries
Symposium, on Friday, June 22. For more information about this
meeting, call the Foundation for Research of Natural Therapies,
Foster City, CA 415/349-0718 (fax 415/349-1257).