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The Current State of Corticosteroid Treatment in HIV Disease
Mar 4, 2005

Dear doctor, Last year a British group published the results of a 10-year long study of low-dose prednisolone in 44 moderately advanced HIV patients. The results were mixed, but reported as good (over-all).

I read that HIV disease is primarily caused by the death of dendritic cells (means unknown), the non-specific (to an antigen) over activation of CD8+ T cells, and self-destruction (via programmed cell death) of CD4+ T cells. In addition, I read that the bone marrow, thymus and lymph nodes are all irreversibly negatively impacted early in HIV disease

Could you please provide some insight into how a corticosteroid like prednisolone interrupts HIV's pathways of destruction and preserves dendritic cells, CD8+ T cells and CD4+ T cells?

Did ten years of low-dose predisolone cause any of the 44 British HIV patients to suffer any side effects (destruction of blood vessels feeding the hip joint tissue, etc)?

I've been using a topical corticosteroid (BetaVal) to treat mild psoriosis on my hands, arms and tail-bone areas for seventeen years (since becoming HIV+). I would have painful, bloody open sores during the dry months without my BetaVal.

My CD4+ T cells remain >1,000 cells/mml (nadir ~700 cells/mml), thanks to early NRTI treatment, and perhaps thanks to early BetaVal use.

Are any of your patients using an oral or topical corticosteroid?

Are any American researchers looking into the use of low-dose corticosteroids in early HIV treatment? If not, why not?

Thank you, Tom

Response from Dr. Pierone

I don't know the details of the British study that you reference, but there was an interesting German study of long-term low dose prednisolone use presented at the International AIDS conference in Bangkok last summer. I spoke with the author and he say no serious side effects related to prednisone, but the study was not looking systematically at this issue. I have had a few patients that have been on long-term oral corticosteroids for treatment of non-HIV-related conditions. The numbers are a handful, but my patients have done well off HIV therapy. There are many people with HIV on steroid creams, but in most circumstances not enough of the steroid is absorbed into the bloodstream to affect the immune system. The exception would be regular use of potent steroid creams, especially over large areas of skin.

The study that should be done now is a placebo controlled trial of low dose prednisone for HIV infection. It is not being done anywhere that I know of. In our upside-down, medical research establishment, there is no financial incentive for this line of research, and further studies will depend of the efforts of some under-funded investigator someplace.

The future....
CROI Dendritic Cell Vaccine

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