Hit harder than HAART
Authors: Richard De Lancie
Journal: The Lancet (2000)

In the introduction to their article on treatment for HIV-1, Mark Harrington and Charles Carpenter (June 17, p 2147)1Harrington M Carpenter CCJ Hit HIV-1 hard, but only when necessary.Lancet. 2000; 335: 2147-2152Summary Full Text Full Text PDF Scopus (101) Google Scholar say: “… no available regimen can eradicate HIV-1; all currently effective regimens may cause undesirable, sometimes life-threatening, toxic effects; and, unless regimens are strictly adhered to, multidrug resistance can develop, limiting future treatment options.” One would conclude that all three of these features had been confirmed beyond question. This is not the case. Treatment is available for which the second and third features do not apply. This treatment is called topical immune modulation (TIM); the modulator is dinitro-chlorobenzene. Many encouraging articles about this treatment have been published in peer-reviewed journals.2Stricker RB Goldberg B Epstein WL Topical immune modulation (TIM): a novel approach to the immunotherapy of systemic disease.Immunol Letters. 1997; 59: 145-150Crossref PubMed Scopus (10) Google Scholar, 3Traub A Margulis SB Stricker RB Topical immune modulation with dinitrochlorobenzene in HIV disease: a controlled trial from Brazil.Dermatology. 1997; 195: 369-373Crossref PubMed Scopus (16) Google Scholar, 4Oracion R Adams M Sharp K et al.DNCB treatment of HIV-infected patients leads to beneficial immunological outcomes, reduced viral loads, and improved measures of quality-of-life.J Invest Dermatol. 1998; 110: 476Google Scholar These articles include reports on several pilot studies and two clinical trials. All show that TIM works. The need for treatments such as TIM was emphasised by Joshua Lederberg, when he wrote “… our focus on extirpating the virus may have deflected less ambitious, though more pragmatic, aims, including learning to live with the virus by nurturing in equal measure the immune system that HIV erodes.”5 TIM does just that. Furthermore, with TIM there are no significant side-effects, there is no multi-drug resistance, and difficulties with compliance are minimised. Perhaps more important, dinitrochlorobenzene costs less than 1% of HAART drugs, so TIM can be afforded worldwide, and no technical or complicated medical delivery system is required. At a time when the world is wringing its hands about a crisis that is threatening both US national security and the capacity of some African countries to function, one would think that anything offering some ray of hope would generate intense interest. For this reason I cannot understand why Harrington and Carpenter do not acknowledge TIM. When I ask people why there is so little interest in TIM, a common response is that TIM has not proved itself as a stand-alone treatment. What they mean is that it has not been subjected to controlled, randomised, double-blind clinical trials, which is true. Funding a trial of a substance that does not have a significant profit potential is extremely difficult. Because dinitrochlorobenzene is in the public domain, it lacks that potential. So pharmaceutical companies show little interest in dinitrochlorobenzene and, as a consequence, funds have not been available for the necessary research and clinical trials to establish it as a standard of care. That, in turn, has meant that TIM, the only treatment now available that could make a difference in Africa, has been ignored, with catastrophic consequences. Until those who have made HAART the standard of care re-examine their emphasis on HAART, there is unlikely to be a change. If Harrington, Carpenter, and others playing a part in defining treatments for HIV disease take a serious look at TIM, particularly for its potential in the developing world, there may be hope for Africa. None now exists.