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Host-Directed Therapy for AIDS
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
Stricker and Goldberg suggest that DNCB is used by thousands of HIV-infected patients around the world at a cost of pennies a week [1]. Although the cash outlay for DNCB is modest, the actual cost of this therapy may be substantially greater. The clinical value of DNCB is currently uncertain. Several uncontrolled studies have suggested that some patients treated with DNCB may experience increases in the number of circulating CD8+ lymphocytes; in some instances, increases in the number of CD56+ lymphocytes (cells with a natural killer phenotype) were also seen [2, 3]. These observations must be confirmed by carefully controlled trials; moreover, the significance of these laboratory findings must be correlated with indices or evidence of clinical benefit.
Broad use of unproven therapies outside of controlled clinical trials can result in misinterpretation of potentially biased results, such as the contention that patients compliant with DNCB do better than those who are noncompliant[3]. A second cost of widespread use of unproven therapies is the potential loss of access to established therapies if patients mistakenly believe they are receiving a therapy of confirmed benefit.
Although I cannot speak for the medical community, I suspect that the results of a well-controlled trial of DNCB would be received with great interest. Widespread use of DNCB outside of clinical trials, however, should not be encouraged.
Michael M. Lederman, MD
Case Western Reserve University; Cleveland, OH 44106
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
