OxyFile #154


HIV-Related Fatigue and Hyperbaric Oxygen Therapy

Reillo, M, R.N., B.S.N.,
Myers, R., M.D.,
HBO Staff, MIEMSS,
Baltimore, Maryland, USA

Objectives:

Hyperbaric Oxygen Therapy (HBO) is being evaluated to determine the 
effectiveness in relieving HIV-related fatigue and determine the 
clinical and immunological effects on HIV-infected individuals.

Methods:

Twenty-five patients have been enrolled over a two-year period. 
Admission criteria include chief complaint of fatigue, seropositivity 
as confirmed by ELISA and Western Blot for HIV infection, 500 CD4
cells or less, and absence of active opportunistic infections which 
might compromise pulmonary or neurologic function.

Twenty patients received 2 ATA, for 90 minutes, three times per week.

Five patients voluntarily received surface air at the same parameters 
to control for a placebo effect, and then received 100% oxygen; all 
patients were treated simultaneously in the HBO chamber. Withdrawal of 
HBO therapy for one month was completed for 21 patients, secondary to 
chamber construction.

Laboratory, clinical assessment, and Karnofsky Performance Scores were 
completed monthly on all patients.

Results:

All patients indicated relief of debilitating fatigue within two 
weeks. Karnofsky Scores improved 10% to 30% within one month. Weights 
for all patients remained stable or increased; CD4, Hemoglobin, and 
Hematocrit counts remained stable and/or increased.

Tumor Necrosis Factor decreased in 13 patients. P-24 antigens remained 
non-reactive or decreased if reactive. Withdrawal of therapy for one 
month secondary to new chamber construction for all but four patients 
correlated with return of baseline fatigue levels.

Additionally, two patients developed PCP and were treated outpatient 
with dapsone and HBO via monoplace chamber.

One patient developed herpes zoster and was treated with zovirax and 
HBO via monoplace chamber.  After resuming HBO therapy, all remaining 
patients returned to their six month Karnofsky Score, which indicated 
significant improvement in their fatigue levels.

Twenty-three of the twenty-five patients have shown no clinical 
disease progression; 80% of patients enrolled in the study have 50 CD4 
cells or less.

Further, HBO appeared to relieve pain associated with peripheral 
neuropathy in two patients and was a beneficial adjunct to the 
treatment of mild PCP; the investigators have established protocols to 
further investigate these findings.

Conclusion:

The study is ongoing. HBO appears to be effective in relieving HIV-
related fatigue and improving the quality of life of individuals with 
HIV/AIDS.

Preliminary research indicates a probable correlation with an increase 
in length of employment capability, delayed disability requirement, 
and reduction in number and length of hospitalizations by 
incorporating HBO as a component in the medical management of HIV 
disease.

The investigators believe HBO may relieve fatigue by inhibiting the 
activity of certain cytokines, enhancing red blood cell production, 
and enhancing the ability of HIV-impaired monocytes to absorb and 
utilize oxygen.

The Center for Advancement of Hyperbaric Medicine is a Washington 
corporation and has filed for IRS non-profit status as a 501(c)(3) 
organization. CAHM's goals are:

1. To promote the acceptance and broadest appropriate application of 
hyperbaric oxygen therapy in the professional medical community.

2. To research and promote the research of promising applications of 
hyperbaric oxygen therapy in a manner that will insure its highest 
professional recognition and acceptance.

3. To collect, organize and disseminate all available information 
about hyperbaric oxygen therapy so as to insure its most knowledgeable 
application and implementation.

4. To discover, research, develop and introduce new medical 
applications for hyperbaric oxygen therapy.

5. To distinguish inappropriate, ineffective or fraudulent application 
of hyperbaric oxygen therapy and to discourage their practice.

Hyperbaric oxygen therapy consists of sitting in a closed chamber in 
which the pressure is elevated to twice that at sea level (14.7 PSI X 
2 = 29.4 PSI 'pounds per square inch'), and then breathing pure oxygen 
(while in the chamber).

The typical course of treatment is about 90 minutes two to three times 
per week.  This therapy is an established therapy for 13 recognized 
conditions and experimental in may more. It is practiced in hospitals 
throughout the United States and the world.

The Center for Advancement of Hyperbaric Medicine can provide 
treatment on your physicians prescription. This is *NOT A COMMERCIAL 
VENTURE* the application to AIDS/HIV is experimental and investigatory 
in nature.

CAHM can be reached at 1720 130th Ave. NE.,
Suite 103,
Bellevue, WA 98005,
Phone (206) 883-7819
FAX (206) 881-1795

or rapid pass along on INTERNET at wombat@u.washington.edu
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  June 6, 1993