A Dream Come True By Robert A. St. Genis Source: City - April 17 - May 15, 1995 In October, 1990 a friend of Michelle Reillo's came to her asking for help. He had zero CD4 cells and was suffering from the severe fatigue associated with HIV. Reillo, aware that fatigue, which often gets confused with depression, is one of the more debilitating symptoms of HIV and causes people to stop working and socializing, was concerned. But, what was the answer? That night she had a dream. In the dream, Reillo sent her friend on "dives" in a hyperbaric chamber to relieve his fatigue. Initially, she wasn't sure as to why it would work, but the dream was inspiring enough to try it. Her friend, absolutely desperate, agreed and Reillo brought him to The University of Maryland Shock Trauma, where she was then a nurse, to begin treatments. Reillo had her friend dive at the equivalent of 33 feet below the water surface three times a week. Within a month, the man's fatigue disappeared. Reillo then went through the procedures to be granted a study at the University of Maryland. The three-year study involved 25 patients who were treated with 100 percent oxygen at 33 feet three times a week for two months, then twice a week thereafter. The results showed that 13 patients had a statistically significant decrease in tumor necrosis factor (TNF), which is one factor that causes fatigue in HIV-infected individuals. In addition, these patients all had an increase in appetite and thus in weight. If nothing else, Reillo's study made her confident in saying she had improved the quality of life in her patients. Despite the results of the initial study, the University of Maryland abandoned funding future studies or treatments for HIV-positive individuals in 1993. Reillo says that the National Institutes of Health was contacted while she was at the University of Maryland on a number of occasions. She notes that Dr. Anthony Fauci was faxed by Search Alliance and urged to examine hyperbaric oxygen therapy (HBO) in 1992. Dr. Michael Gottleib of the UCLA Medical Center was also contacted and spoke with Reillo. The University of Maryland submitted three grant applications to NIH, none of which were approved. The University of Southern Alabama separately applied for a grant to continue their research on hyperbarics and was also denied. Reillo and some patients who were part of the University of Maryland study believe it's because of the lack of financial incentive. "The politics of AIDS around pharmaceuticals are horrible," Reillo said. "Hyperbarics should not be a threat." Determined to continue her research, Reillo used her own money along with bank loans to open Life Force in Baltimore at 1006 Morton Street. After purchasing and having a chamber installed, completing all other construction, and providing the facility with the necessary office equipment and furnishings, Reillo opened her doors in August, 1993. Since then, she has continued treating 13 of her original patients, in addition to about 130 others. She maintains about 50 "compliance patients," explaining that many quit the treatments after they feel better. Reillo's persistence has led her to surmise that HBO treatments reduce the viral load in patients by a biochemical reaction whereby oxygen binds to an amino acid and zinc peptides, which are required for RNA replication of HIV. In addition, Reillo has concluded that HBO therapy, along with medication, helps reduce the recovery time for PCP. A study on the latter discovery was written in the April, 1995 issue of AIDSPatient Care. While other research is limited, Reillo is not alone. At the International AIDS Conference in August, 1992 in Florence, Italy, a study was released by Drs. Brazelle, Ryan, and Harley which determined that oxygen under pressure reduces the viral load in patients systems. Laer, at the August 1994 International AIDS Conference in Tokyo, Dr. C.R. Steinhart, Dr. I. Montoya and M.R. Kaiser of Mercy Hospital, Miami, noted that "in three of four patients with mid to late stage disease, HBO subjectively improved quality of life and reduced fatigue." In 1993, The Israeli Naval Hyperbaric Institute conducted a single exposure study in non-HIV infected human subjects and found that HBO causes T-cell subpopulations to shift. A 1994 study at the Israel Navel Medical Institute conducted on non-HIV infected rats indicated again a shift in T-cells, with there being a decrease in the blood, but increase in the lungs, lymph glands, and spleen. Their hypothesis for this is that they "may represent the activation of protective mechanisms against the toxic effect of oxygen or the early stages of pulmonary oxygen toxicity. Toxicity is one concern that is often voiced about HBO therapy. At Life Force, Reillo makes sure that her patients receive antioxidant medications as part of their treatment and none of her patients have faced any problems with toxicity. Further, a 10 year study showed that out of 1,505 patients, non suffered pulmonary oxygen toxicity or ocular refractive changes and only .009 percent suffered oxygen convulsions, which ceased after removing the masks from the patients. However, it should be noted that the Under Sea Hyperbaric Medical Society has not yet endorsed hyperbarics for treating HIV. The costs of hyperbaric oxygen therapy is another consideration. Life Force charges $125.00 per session for visits. This fee is considered low compared to other hyperbaric clinics, but a "maintenance patient" will face over $1,200 a month in charges for the therapy. Many insurance companies will cover hyperbaric if prescribed by the patient's physician. Reillo says she will not turn anyone away because of their inability to pay. "If people don't have any insurance, we will work something out." Dr. Mark Smith of Tucson, Arizona, feels that "cost is all kind of relative in this disease. Depending on what the (HIV) patient is facing, they can expect $10,000 to $15,000 a month at times (for treatment and care)." He continues, "For what [HBO] does in comparison to AZT, it's relatively low." Smith, infected with HIV and with zero CD4 cells, has purchased his own hyperbaric oxygen chamber and has been administering HBO treatments since May, 1994. Smith has had tuberculosis and PCP and only weighed 110 pounds when he started. Today, he weighs 160 pounds, is able to work out three times a wee, and claims "if it weren't for hyperbarics, I probably wouldn't be here today." Smith doesn't want to speculate why more people aren't investigating hyperbarics, though he explains that "the theoretical negatives are far more unproven than the positives we have proven to date." Reillo's patents are equally enthusiastic. Tim Good, 47, HIV positive for eight years, claims, "The has stopped the progression by about 83 percent since I started. This is a great deterrent. This is one of the great unknown treatments." Tom, 38, HIV positive for 10 years and a patient of Reillo's for the past four also believes that HBO treatments have stopped the progression of the disease, stating, "I have tried a dozen types of experimental therapies and this is the only one that has worked. The proof is I'm doing nothing else right now, no drugs or anything and my counts remain stable." Doug Garriott, 52, HIV positive since 1982 and one of Reillo's first patients doesn't understand why more people aren't coming for treatment, stating, "I certainly think [HBO therapy] kept me alive for the last four years and I know it can do that for other people." Hyperbarics are not new to the world of medical science. For more than 30 years, the U.S. Navy has used hyperbarics for treating deep sea divers suffering from the bends, a potentially fatal condition that is cause by surfacing too quickly. Dr. John M. Alexander at Northridge Hospital Medical Center in Los Angeles, once a Naval medical officer, now uses hyperbarics to treat such patients as diabetics with foot ulcers that don' heal, cancer sufferers with radiation-induced tissue damage, and victims of carbon monoxide poisoning. Hyperbaric treatments for non-diving diseases date back to 1950s when surgeons used the treatments to carry out cardiovascular procedures that required stopping blood circulation. They were abandoned for this purpose with introduction of heart-lung bypass machines and widely disregarded in general in the mid 1970s. Yet, while there were only 37 facilities operating in the United States in 1977, there are nearly 260 today. Still, despite evidence showing positive effects of hyperbarics in areas outside of HIV, hyperbarics "remains an ill-defined field, and HBO data often consists of small (test) series without standardized patient populations or treatment schedules," according to a 1990 article in the Journal of The American Medical Association. Most organizations involved with HIV also remain uninformed and in certain cases simply disinterested. The AIDS Information Clearinghouse, operated by the Centers for Disease Control, had no information available regarding HBO therapy, stating that they only tend to hold information regarding pharmaceutical-based options. The National Association of People With AIDS was not able to locate any information on hyperbarics. Project Inform and The Gay Men's Health Crisis did not respond to inquires regarding the form of treatment. Contrarily, the National Institute of Allergies and Infectious Diseases, who did have access to some material including Reillo's studies, stated, "At the current time, we are not supporting research in hyperbaric oxygen therapy nor have we seen a formal submission of data. We do, however, always welcome interesting data and would look forward to the results of additional research." The AIDS Treatment Data Network was able to reply with the above mentioned Steinhart and Bitterman studies, in addition to Reillo's and has voiced an interest in more information. For hyperbarics to gain any real recognition, whether it be in treating food ulcers or symptoms associated with HIV, it is evident that controlled studies need to be conducted. The health care profession is, at best, skeptical about treatments that have not been sufficiently researched and most patients are comforted knowing that doctors do not prescribe treatments that may not benefit their patients.