Aspirin Update: Warning, Promise, and Call for Information by John S. James

Last August 17, AIDS TREATMENT NEWS published an in-depth look
at the possibility that ordinary aspirin might have a role in AIDS
treatment -- as an immune modulator, not just for minor symptom
relief. One of the physicians we interviewed, Joseph Sonnabend, M.
D., in New York, called recently to warn us of the importance of
medical monitoring with aspirin use -- especially the need to follow

platelet count. He has seen one case of serious hemorrhage in a
patient with a rapidly falling platelet count, who was taking two
325-mg aspirin tablets four times a day. Fortunately, this person
recovered.

Dr. Sonnabend suggests that anyone with a platelet count of
under 100,000, or who has ever had thrombocytopenia (low platelet
count), should have frequent medical supervision if they use
aspirin, or other drugs which can interfere with blood clotting.
Anyone with HIV should be monitored by their physician if they use
aspirin.

Background note: platelets assist in blood clotting. Platelet

counts often decline in persons with HIV infection. For unknown
reasons, this decline is usually less serious than if the same
numbers occurred in persons without HIV -- and platelet counts often

become normal again as HIV infection progresses. Bleeding problems
due to low platelets have been rare with HIV infection; but the case

mentioned above shows that risk does exist, and appropriate
precautions are necessary.

A Report of T-Helper Improvement

We have heard of one case of an unexpected major improvement in

T-helper count after low-dose aspirin use. We are reluctant to
mention a single case until there is confirmation; but here, the
patient was in an NIH epidemiological study and has very good data
available -- quarterly T-helper and other blood counts from a
quality-controlled lab for the last six years. We also chose to
mention this case because it suggests that an easy-to-organize
community-based trial could tell quickly if the effect is real, or
just a chance result in one case.

This patient's T-helper count had declined for four years, then

stabilized at an average of about 500 with AZT; he has taken 500 mg
of AZT per day for two years. He started taking a single 325-mg
buffered aspirin tablet per day near the end of August, 1990. His
last T-helper count before starting aspirin was 553. By mid
September the count was unchanged at 556, although the
helper/suppressor ratio had changed from .56 to .78. By mid
November the count was 895, and by mid December it was 968 (the
November test was to apply for a different NIH study). The T-helper
percent and helper/suppressor ratio showed substantial increases.
There was no other change in therapy or other known factor which
would explain these improvements.

The patient had selected the low dose (one aspirin a day)
because of a report [1] that an even lower dose (one aspirin every
other day) had the greatest effect in increasing both interleukin-2
(IL-2) and interferon gamma in healthy volunteers. In this study,
IL-2, which stimulates the growth of T-cells, was increased to two
to three times baseline levels by low-dose aspirin.

Questions for a Clinical Trial

* The first question for a trial to answer is whether aspirin
can have any consistent effect in raising T-helper counts, or if the

effect reported above was just happenstance or only applied to one
patient. Clearly it would be easy to run a trial with low-dose
aspirin, and follow T-helper counts for at least three months.

Some other questions:

* Is antiviral therapy (in this case, AZT) necessary?
Stimulating the growth of T-helper cells without antiviral therapy
might increase the growth of the virus. We have heard good results
from studies which combined IL-2 and AZT; one early report found a
T-helper increase of over 300 during IL-2 therapy, although the
increase disappeared after treatment was stopped [2]. (As we went to

press, we learned that results of an important trial at Stanford
University of combination HIV treatment with IL-2 and AZT have
recently been published; we could not obtain this paper by press
time.) If low-dose aspirin does indeed stimulate the body to
produce more of its own IL-21, then aspirin might be an alternative
easier to obtain, safer, and of course less expensive than the
experimental pharmaceutical IL-2.

* Could this treatment approach also work for persons with
lower starting T-helper counts? A community-based trial could
accept volunteers with a range of T-helper values. Then -- if any
significant effect is seen -- the researchers could look for a dose-

response relationship.

Call for Information

Any information about long-term use of aspirin, and its effect
(or lack of effect) on T-helper counts, could be helpful for
designing such a trial. If you have information we should know
about, contact John S. James at AIDS TREATMENT NEWS.

References

1. Hsia J., Simon GL, Higgins N, Goldstein AL, and Hayden FG.

Immune modulation by aspirin during experimental rhinovirus colds.

Bulletin of the New York Academy of Medicine. January 1989; volume
65, number 1, pages 45-56. (Note: the data cited above was from
volunteers who did not have colds.)

2. Bartlett JA, Blankenship K, Waskin H, Sebastian M, Shipp K,
and Weinhold K. Zidovudine and interleukin-2 in WR2 HIV infected
patients: Evidence for stimulated immunologic reactivity against
HIV [abstract S. B. 421]. Sixth International Conference on AIDS,
San Francisco, June 20-24, 1990.

Note: For background on aspirin, and what is known or not known
about its different mechanisms of action, see the latest Scientific
American, January 1991, pages 84-90.

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