THE BONUS ROUND PRESENTS

Part Two:  Dickie's Personal HIV Theory.
The NICKEL Tour

by Dick Remley, every doctor's nightmare:
A PATIENT WITH AN INFORMED OPINION

---

PART TWO: THE NICKEL TOUR The THEORY proposes that, when particles of HIV first enter a person's body, that person's body, having never been exposed to this disease before, has no effective defense against it.   The body must manufacture a new antibody to neutralize the invading HIV.  This process apparently can take up to six months, during which time the virus moves about freely and operates relatively unfettered. I propose that it is during this early period that the greatest number of cells are successfully infected by HIV.  Once the antibody to HIV has been formed, any virus in the bloodstream is quickly attacked and destroyed, and the virus can no longer move freely through the bloodstream to infect other cells.  But the virus survives, hidden inside the cells it successfully infected before the antibody appeared. These chronically infected cells persist for years, forming a "reservoir" of live virus.  This would result in an apparent "latent" or "dormant" phase of the disease. It would also result in a "set-point" phenomenon in which the reservoirs of infected cells continue to produce virus at a certain level.  Variations in this viral level may be brought on temporarily by environmental factors, such as the introduction of other diseases, or the initiation of drug therapy, which would disrupt viral reproduction in some way.  But removal of the cause of the disruption would always result in HIV levels returning to their "set-point", because the reservoir of infected cells hasn't been killed, and newly created virus has been unable to infect new cells. The THEORY is also predicated on the idea that the body's immune system is not "worn out" as many had believed (and some still do).  Rather, the immune system is "confused" - intentionally misled by the virus' ability to hijack the communication system between cells.  Many now subscribe in one way or another to this part of The THEORY.  A "die-off" of infected cells should theoretically allow the immune system to restore itself.  This prediction has proven to be true by the reconstitution of the immune system during effective treatment with protease inhibitors and other antiretrovirals. The THEORY proposes that, once infected, a cell's ability to communicate with other cells becomes disrupted and sends "false signals" -- or NO signals -- to the immune system, causing it to shut down some parts of the immune response, while hyperactivating it in others. The THEORY also predicts that, under some circumstances, treatment with certain immunosuppressive agents (such as prednisone or even aspirin) could result in an unexpected rise in T-cells. This has also been observed. From a treatment standpoint, what this means is essentially very simple: Since what matters most is not how much virus is detectable in your bloodstream, but how many CELLS are virally infected, a simple, effective treatment would be one that destroys virally infected cells, rather than relying on retarding viral replication.  Cell death is the major key component to The THEORY. Unfortunately, as far as we know, no one has yet figured out how to target only infected cells with a cytotoxin (a substance poisonous to cells).  Currently approved therapies rely on interrupting the viral reproductive process, and waiting for cells to die off on their own.  The THEORY predicts that this is likely to leave a reservoir of live infected cells that may at some point produce a mutation resistant to treatment. (This is, in fact, what we see in actual practice now.) So, if killing off infected cells should be the goal, but we have not yet reached that goal, is there an alternative? I think there is, but the very idea of it has terrified virtually every doctor to whom I've ever explained The THEORY.  The alternative would be to kill off immune cells regardless of whether or not they are infected, and let the immune system restore itself naturally.  This, of course, would require a strictly supervised procedure in a patient absent of any potentially damaging infection.  It is likely that killing off ALL the immune cells would prove unnecessary.  Killing off a substantial number of cells might be sufficient.  This part of the theory predicts that useful treatments might include already available and relatively inexpensive treatments for leukemia.  This has proven to be true in the case of hydroxyurea, which was finally researched and is now used in "salvage therapy" treatments when other medications have failed.   It might be best to use hydroxyurea as a "first line" treatment, however, in order to avoid potential complications from blood cell disorders that commonly occur in late-stage patients.  There are likely to be other drugs that work as well or better than hydroxyurea already on the market. In addition, The THEORY also predicts that, against the expectations of most - if not all - other theories, an HIV-positive patient being readied for a bone marrow graft (either from a human donor or a baboon or whatever) would eventually recover a significant part of his immune function, despite failure of the marrow graft.  This phenomenon has been observed as well.  I think it is too much to hope that we could ever destroy the total reservoir of infected cells by this - or any other - method.    Eventually, you would expect to see viral rebound, and the process would have to be repeated - perhaps every 12 to 18 months or so. Obviously, with the advent of HAART (Highly Active Anti Retroviral Treatment), the ideal thing would be to combine BOTH therapies; and treat the patient with currently available anti-HIV regimens while the immune cells are being restored by the body. That's essentially it - in extremely simplified and condensed form. (But at least it's understandable when it's condensed to this point.) For those of you who want more detail, I offer the "THE DIME TOUR" explanation immediately following this summary. If you want still more information - and enjoy being confused as heck - a detailed examination of the possible mechanisms involved follows THE DIME TOUR, under the heading of "THE FULL MONTY".  (WARNING! "THE FULL MONTY" explanation is highly technical, and has been known to give even students of microbiology very severe headaches.) On to THE DIME Tour

A DISCLAIMER FROM STEVE SCHALCHLIN: Dickie is my friend in Los Angeles who was infected with HIV in 1981. He's been through more near death experiences than anyone I know, including a recent two month delirium where his liver was failing and he was dying. But through a careful balance of some drugs that alternatively dehydrate and then rehydrate him, he is alive yet again.  Dickie, after he got sick, began reading books on microbiology. And when we met earlier this year, he used to sit for hours and just explain for me microbiology and all the sites on the cells and what proteins do, etc. He kept telling me about his theory about the immune system. He had it well thought out and, as far as he could tell, it -- THE THEORY -- can account for all the phenomena that has occurred so far in the strange tale of HIV.  This does not mean he is right. His theory is untested. It is ONLY theory. It came to him as he read book after book on microbiology, so it could be a naive theory or it could be one of a billion theories. So why have I invited him to be a Bonus Round site?  Because when he's hot on the trail of new information and when ideas are popping in his head; when he's making new discoveries through the books and published studies, I see him come back to life the same way Jimmy saw my songs bringing me back to life.  There are scientists who read my page, you know. Even if his theory doesn't pan out, I will learn a lot about my own body and about the thing that almost killed me. (cue song: "at least i know what's killing me").  Dickie is not a doctor nor does he work in the medical field.  He's a Patient. *cue the mannix theme*  So, the reader should note that THIS IS ONLY A THEORY we are using as a jumping off point to ask questions and learn more about HIV and the immune system.  WE ARE NOT SUGGESTING ANY PATIENT TRY ANY METHOD OF TREATMENT WHICH MIGHT BE SUGGESTED OR INFERRED. WE ARE NOT RESPONSIBLE FOR YOU IF YOU DO SOMETHING STUPID -- LIKE TRY ANY TREATMENT WITHOUT THE FULL CONSENT OF A LICENSED MEDICAL DOCTOR.  Tell us what you think. -- The Bonus Round Management. :-)

© 1998 by Richard Remley (deceased)