Dobri D. Kiprov

Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection

Dendritic cells, the primary antigen presenting cells of the human immune system, are heavily infected with human immunodeficiency virus (HIV) in patients with the acquired immunodeficiency syndrome (AIDS). Dinitrochlorobenzene (DNCB) is a contact sensitizing agent that acts as a potent immune modulator of dendritic cells. In this pilot study, we examined the safety and efficacy of topical DNCB application in patients with early HIV disease. Topical DNCB was well tolerated by these patients, with an adverse reaction rate of 10%. CD4+ T-cell counts remained stable with repeated DNCB use. In contrast, CD8+ T-cell counts and natural killer cells increased significantly following DNCB sensitization. This increase in CD8+ T-cell and natural killer cell subsets was accompanied by a decrease in HIV replication, as measured by serum HIV RNA levels. Based on this pilot study, we conclude that topical DNCB is safe in early HIV disease and may decrease viral load via a systemic effect on dendritic cells, CD8+ T-cells and natural killer cells. These results require confirmation in larger controlled trials.

Plasmapheresis in Immunologically Mediated Polyneuropathies

Abstract:u2003 One of the most common uses of therapeutic plasmapheresis is for the treatment of immunologically mediated polyneuropathies. This paper discusses the use of plasmapheresis in Guillain‐Barré syndrome, chronic inflammatory demyelinating polyneuropathy, polyneuropathies associated with paraproteins, lower motor neuron syndromes, and polyneuropathies associated with HIV. As the pathogenesis of immunologically mediated polyneuropathies becomes better understood, newer therapies for these syndromes will evolve; however, therapeutic plasmapheresis is likely to continue to play a central role in the treatment of many of these diseases.

Exclusive therapeutic apheresis delivery system.

The demand for plasma exchange has grown significantly since the early 1980s after the publication of articles describing the benefits of this treatment modality in a number of serious medical conditions [1–4]. New indications for cytapheresis procedures have expanded the demand for therapeutic apheresis (TA) even further. [5,6] Most TA procedures before the 1980s were usually performed in a research setting [1–4]. With the development of clear clinical indications for TA [7,8], the need for medically and technically competent TA providers became obvious. The Bay Area Mobile Apheresis Program (BAMAP) was conceived as an entity that would: one, provide exclusively TA services to patients who needed them, two, provide a setting for training of physicians and nurses in this new field, and three, be in the forefront of research through participation in clinical trials. Twenty years later, BAMAP continues to be an exclusive TA provider serving patients throughout the state of California. This paper discusses the development, organization and function of this stand-alone TA delivery system.