Newsdesk
Malariotherapy to treat HIV patients?
Can appropriate stimulation of the “A large body of published scientific immune system benefit HIV patients? work shows that malaria stimulates This question is the crux of the the immune system, stimulating the controversy that surrounds the use of production of interferons, interleukins, malariotherapy to treat HIVpatients. and other cytokines”, explains Henry Since a recent investigation found Heimlich (The Heimlich Institute, that a researcher at the University of Cincinnati, OH, USA), a leading proCalifornia at Los Angeles ponent and researcher of (UCLA) had violated federal this therapy. rules by participating in Heimlich, who trials in China between 1993 under the current and 1996 on malariotherapy media glare is being to treat eight HIV-positive highly criticised for his men, malariotherapy is once advocacy of malarioagain in the news. therapy in the treatment Malariotherapy for of HIV patients, HIV touches on both the maintains a position for not-yet-proven benefit of the need to further test immune-based therapy for Heimlich: therapy proponent this therapy. In regard HIV and the issue of approto the outcomes of the priateness. Is it right to treat one disease trial in China, Heimlich says that, with another when there is no evidence “malariotherapy is the only treatment to indicate a benefit? that caused the CD4 count to increase The treatment, based on injecting a for a 2-year period after a single person with a curable form of malaria to treatment. No further treatment of any induce fevers and boost the immune kind was required to maintain this system, has precedence. Before the increase”. advent of antibiotics malaria was used Others around the globe, including to treat neurosyphilis, and more recent the US Centers for Disease Control research has examined its potential to and Prevention (CDC) and a number treat Lyme disease. of infectious disease specialists in
Dan Pinger Public Relations
the field, are sceptical. “Without evidence—either in-vitro or in-vivo— to support the hypothesis that malaria suppresses HIV infection or delays the development of AIDS”, reads a memo by the CDC detailing its official stance on research of malariotherapy, “the use of induced malaria infection in HIV-infected individuals cannot be justified”. Although this memo was written in 1993, it remains the current position by the CDC on this issue, according to a spokesperson. Furthermore, the CDC maintains that, “there is evidence that HIV-individuals in sub-Saharan Africa who also suffer from malaria have worse outcomes”. Paul Farmer, co-founder of Partners-in-health, Harvard Medical School, who works with many HIV patients co-infected with malaria or tuberculosis, and who was approached by Heimlich, put it more tersely when asked if this would be an effective HIV therapy: “it seems improbable. The places where malaria takes its biggest toll are precisely those in which HIV reaps its grim harvest”.
Mary Beth Nierengarten
Improved monitoring of febrile illnesses
A team of US and Egyptian researchers has developed a system to monitor the incidence of febrile illnesses—a tool that could help developing countries collect the information needed to improve health programmes. “Accurately knowing the incidence and causes of febrile illnesses in the population at large is important”, explains team leader John Crump (Centers for Disease Control and Prevention, Atlanta, GA, USA). “Unfortunately, surveillance often only occurs at the hospital level, so only the worst cases are recorded, and frequently no microbiological tests are performed so diagnoses are often wrong. We tried to develop a system that monitors disease in the whole population, that has good sensitivity and specificity, and is yet within the reach of some developing countries.” The team sampled four randomly selected rural sites in the Bilbeis and Fakkous Districts, Egypt, to establish the frequency of febrile illness lasting more than 3 days. 23% of eligible people reported having such a fever in the past 3 months, but only 80% had actually sought medical help, and only 2·1% attended a hospital where disease monitoring was likely. A sentinel surveillance system was established involving hospital and community-based health providers (fever specialists, general practitioners, paediatricians, rural health units, etc). Blood samples collected from all febrile patients examined over the next 4 months were taken daily to laboratories to test for Salmonella enterica serotype typhi (4·2%), non-typhi salmonella (0%), brucellosis (6·9%), Escherichia coli, and Haemophilus influenza (one patient). “When we adjusted the results for the percentage of the population that actually seeks medical care for fever, we found typhoid incidence rates in Bilbeis District to be much lower than those in vaccination studies (13/100 000 people vs 48/100 000) which tend to focus on populations at risk”, explains Crump. “Also, brucellosis was as important as typhoid—in fact, 87% of people with brucellosis had originally been diagnosed and treated for typhoid. Knowing this could lead to more adequate use of limited resources.” “This grassroots system need not always be in operation—making it more feasible for developing countries”, comments Jesus Roche (Instituto de Salud Carlos III, Madrid, Spain).
Adrian Burton
THE LANCET Infectious Diseases Vol 3 June 2003
http://infection.thelancet.com
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