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Date Posted: 13:26:17 01/26/02 Sat
Author: No name
Subject: DRUGS;ETC.

WHAT IS INTERLEUKIN-2?
Interleukin-2 (IL-2) is a protein made by the body. T-helper cells, a kind of white blood cell, produce IL-2 when they are stimulated by an infection. IL-2 makes infection-fighting cells multiply and mature. Patients who use IL-2 have large increases in their T-cell (CD4+ cell) counts. IL-2 is called an immune modulator.

Interleukin-2 has been approved by the FDA for the treatment of some types of cancer, but has not yet been approved for the treatment of HIV disease.

Using gene splicing, the Chiron Corporation developed a way to manufacture IL-2. Their version is called Proleukin®.


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WHO SHOULD TAKE INTERLEUKIN-2?
IL-2 stimulates the immune system and increases the number of CD4+ cells. People who start with higher T-cell counts get larger CD4+ cell increases.

Scientists do not agree on the value of the new T-cells generated by IL-2. That is, a T-cell count of 700 after IL-2 therapy might not be as good as a count of 700 before IL-2 therapy. The difference has to do with how many different types of T-cells you have.

Before HIV disease attacks your immune system, you have a full range of T-cells. There are actually millions of different types of T-cells, but an easier way to think about them is like the letters of the alphabet. Each letter is programmed to respond to one particular type of infection. With a healthy immune system, you have many copies of each letter. As your T-cell count goes down, you have fewer copies of each letter, and you might run out of some letters.

Let's say that you need to spell the word "zebra" in order to fight pneumonia. If you have lost all your copies of the letter "z", you can't spell zebra and you might develop pneumonia.

People who take IL-2 seem to get more copies of the "letters" (types of T-cells) that they still have, but don't get back the ones they have lost. They could still have gaps in their immune defenses.

Scientists are still studying the benefits of the CD4+ cells produced by IL-2 therapy. We do not know if these higher T-cell counts mean that people will stay healthier.

Researchers also used IL-2 to try to clear infected "resting" T-cells from the blood. These experiments were not successful. New studies are examining the possible benefits of IL-2 during treatment interruptions (See Fact Sheet 417).


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HOW IS INTERLEUKIN-2 TAKEN?
IL-2 has been given as an intravenous infusion and as twice-daily subcutaneous (below the skin) injections. Early research showed that the largest increases in T-cells occurred when IL-2 was given every day for 5 days, once every 8 weeks. If the T-cell count climbs enough after the first few cycles, future cycles can occur less frequently.

The best dosage of IL-2 has not been determined. The dosage is stated as "millions of international units", or MIU.


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WHAT ARE THE SIDE EFFECTS?
Without antiviral treatment, IL-2 can increase HIV viral load up to six times its pre-treatment level. These increases disappear within one month. Combination antiviral medication controls these "spikes" in viral load. You should not use IL-2 unless you are taking antiviral drugs.

When IL-2 is given by intravenous infusion, the most common side effect is called capillary leak syndrome. This causes weight gain, swelling, low blood pressure, and other problems.

At lower doses, people taking IL-2 get flu-like symptoms, including fever and muscle aches. Because IL-2 stimulates the immune system, it can make some immune disorders get worse, including arthritis, psoriasis, and diabetes. It can also reduce the number neutrophils, a particular type of infection-fighting cell, and can cause low levels of thyroid.

When IL-2 is given by subcutaneous injection, the side effects are usually milder than with intravenous infusions. There is the added side effect of irritation where the injection is given. Side effects show up from 2 to 6 hours after injection of IL-2, and disappear quickly after the end of each cycle.

IL-2 can cause mood changes including irritability, insomnia, confusion, or depression. These can continue for several days after IL-2 is stopped.


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HOW DOES INTERLEUKIN-2 REACT WITH OTHER DRUGS?
The body naturally produces IL-2. No serious interactions with antiviral medications have been noted. Also, there is no evidence that the body develops resistance to IL-2 when it is given in cycles.


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THE BOTTOM LINE
IL-2 stimulates the immune system and can lead to large increases in the number of CD4+ (T-helper) cells. We still don't know if these increases in T-cells help people stay healthy longer.

IL-2 is usually administered in 5-day cycles of 2 subcutaneous injections a day. One cycle is given every 8 weeks. IL-2 causes irritation where the injections are given and flu-like symptoms. These side effects usually start within a few hours of IL-2 injections and disappear after the end of a cycle.

IL-2 has not yet been approved for use in HIV disease.



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Revised April 19, 2001



WHAT ARE VACCINATIONS?
Vaccinations, or immunizations, are injections that build up your body's defenses against certain infections. For example, many people get flu shots each fall. It can take a few weeks for your immune system to respond after a vaccination.

"Live" vaccines use a weakened form of the germ. They can give you a mild case of disease, but then your immune system kicks in to protect you against a severe case. Other "inactivated" vaccines don't use a living germ. With them, you don't get the disease, but your body can still build up its defenses.

Vaccines can have some side effects. With live vaccines, you might get a mild case of the disease. Even with inactivated vaccines, your immune system will respond. You could have pain, redness, and swelling where you got the shot. You might also feel some weakness, fatigue, or nausea for a day or so.


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WHAT'S DIFFERENT FOR PEOPLE WITH HIV?
If HIV has damaged the immune system, it might not respond as well to a vaccine, or for the same length of time. Also, vaccines might cause more side effects in people with HIV. They might even cause the disease they are designed to prevent.

There has not been much research on vaccines and people with HIV, especially since people started using combinations of anti-HIV drugs. However, there are a few key guidelines for people with HIV:

Vaccinations can increase the viral load (see fact sheet 413) for a little while. However, getting sick with the flu, hepatitis, or other preventable diseases would be much worse. Do not measure your viral load within 4 weeks of any vaccination.
Flu shots have been studied more than any other vaccination for people with HIV. They are considered to be safe and effective.
If your T-cell count (see fact sheet 412) is very low, vaccines might not work. If possible, strengthen your immune system by taking strong anti-HIV medications before vaccination.
HIV-positive people should not receive most live vaccines (see below.) However, the "MMR" vaccine against measles, mumps and rubella is considered safe if your T-cell count is over 200.


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WHICH VACCINATIONS ARE RECOMMENDED?

1. Pneumonia: Having HIV greatly increases your risk of developing pneumococcal pneumonia. The vaccine takes 2 or 3 weeks to become effective. The protection lasts for about 5 years in people with HIV.

2. Hepatitis (See fact sheet 505): Hepatitis can be caused by several different viruses. Vaccines exist for hepatitis A and B. Hepatitis A is usually not serious but it can be for someone with a weakened liver. This includes people who are infected with hepatitis B or C. Getting two hepatitis A vaccine shots can protect you for about 20 years.

Hepatitis B can cause serious disease. If you were exposed to hepatitis B, you should have antibodies. If you don't, you should get vaccinated. A series of three hepatitis B shots should protect you for about 10 years. People who have a higher risk of hepatitis A or B include men who have sex with men and people who use street drugs or who inject drugs.

3. Influenza (Flu): A flu vaccine is offered each year, based on the most active type of flu. Flu shots are recommended for all people with HIV. For best protection, you should get the shot by mid-November, before flu season. A case of the flu can sometimes develop into pneumonia. Some flu vaccines can cause an allergic reaction in people who are allergic to eggs.

4. Tetanus and Diphtheria: Tetanus is a serious disease caused by common bacteria. Tetanus infection can occur in any cut in the skin. It cannot be passed from person to person. Injecting drug users have a higher risk of a tetanus infection. Diphtheria is another bacterial disease. It can be passed from person to person and is common in homeless people. Diphtheria vaccine is always combined with tetanus vaccine.

Tetanus and diphtheria vaccines are usually given to children as a series of three shots. A single booster shot can be given every ten years. People with HIV should not receive the shots more than once every 10 years, or else they might have a painful local reaction. The shots can cause a lump that can last for a few weeks.

5. Measles, Mumps and Rubella: These are three diseases caused by viruses. They are very contagious and can be spread by coughing or sneezing. Children are normally vaccinated against these diseases with an "MMR" shot. The vaccine usually gives life-long protection against these diseases. If you were born after 1957 and did not get these vaccines as a child, you should get an MMR vaccination. However, since this is a live vaccine, it is not recommended for people with a CD4 cell count below 200.


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HIV-POSITIVE TRAVELLERS
Every traveler with HIV should be sure they are vaccinated against hepatitis A and B.

Countries have different vaccination requirements for entry. In general, inactivated vaccines should not be a problem for travelers with HIV. However, they should avoid live vaccines, including typhoid, yellow fever, and vaccinia. If polio vaccine is required, it should be the inactivated version, not the live oral version.

Instead of getting a live vaccine, people with HIV should get a doctor's letter explaining that they have a medical reason not to be vaccinated. This is accepted by most countries.


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Revised January 19, 2002


WHAT ARE ALTERNATIVE THERAPIES?
A health treatment that does not fit into standard western medical practice is called "alternative" or "complementary". This includes many different therapies:

Traditional healing practices such as ayurveda, Chinese acupuncture, and Native American healing
Physical therapies such as chiropractic, massage, and yoga
Homeopathy or herbs
Energy work such as polarity therapy or reiki
Relaxation techniques, including meditation and visualization.
Some doctors don't like alternative therapies. They want to see more research on these therapies. They think that patients would probably do better if they use western medicine.

Other physicians like to use alternative therapies along with western medicine. They think alternative therapies can reduce stress, relieve pain or stomach upsets caused by many antiviral drugs, or have other benefits for patients.


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HOW MANY PEOPLE USE ALTERNATIVE THERAPIES?
Alternative therapies are very popular. In the United States, over 70% of people with HIV have used some kind of an alternative therapy. Many people use them regularly. Some health insurance plans pay for therapies such as chiropractic or acupuncture.


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ARE THEY SAFE?
Alternative therapies can have dangerous side effects. The words "natural" or "non-drug" do not guarantee safety. The FDA (Food and Drug Administration) does not approve dietary supplements or monitor their safety or contents. Some herbs can lower blood levels of antiviral drugs. Consumers need to be careful when using alternative therapies.


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DO THEY REALLY WORK?
It is difficult to find good information on alternative therapies. Get as much information as you can before using them. Try to find out:

When and how was this therapy developed?
How does it work?
Are there any articles or studies of this therapy?
Are the therapists trained, certified, or licensed?
Are there any known side effects or other risks?
Sometimes this information is truly not available. However, if it seems like people don't want to answer your questions, be extra careful. You might be dealing with a health fraud. See Fact Sheet 205, How To Spot HIV/AIDS Fraud, for more information.


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WHY AREN'T THERE MORE STUDIES OF ALTERNATIVE THERAPIES?
Most research tests treatments for a particular disease or condition. Every patient gets exactly the same treatment. Many alternative therapies don't fit this model of health care, and there may be no sponsor to pay for the research.

Specific Disease or Condition: Some alternative therapies treat the whole person, not an illness. They might restore harmony, balance, or normal energy flow. Acupuncturists, for example, use the pulse to find out how your body's energy might be out of balance. Acupuncture for people with HIV is based on their individual energy pattern, not on their HIV. Therapies like this are not designed to treat HIV, although they might help some HIV-positive people. Some dietary supplements appear to work directly against HIV, but better studies are needed to confirm this.

Standardized Treatment: Few alternative therapies are standardized. Different brands of herbs can have different amounts of the active ingredient, although more standardized products are being made. Chiropractic, acupuncture, and other therapies are not standard: they are adjusted for each patient. Research is very difficult when treatments are not standardized.

Safe Treatments: The FDA wants to know that a therapy is safe before they test how well it works. Even if many people have used a treatment for many years with no reports of health problems, a scientific study is usually required to show that it is safe.

Paying for the Study: Scientific research is very expensive. The makers of alternative therapies often cannot afford to pay for scientific studies. The government prefers to pay for studies of western medical drugs because they appear to be more effective. Patents allow drug manufacturers to make large profits that help pay for research; most alternative therapies cannot be patented.

Despite these barriers, some alternative therapies have been carefully studied. Often, this research has been conducted outside the US. Unfortunately, the FDA has no procedure for evaluating the results of non-US research. The Fact Sheets for each alternative therapy mention research that has been done.


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WORKING WITH YOUR DOCTOR
Tell your doctor as much as possible about how you want to deal with your HIV infection. It's best if you tell your doctor about all the therapies you use. This is very important if you have any kind of bad reaction to a medicine that you are taking. There could be some alternative therapies that you should not use together with your HIV medications.

Check your doctor's attitude and knowledge on alternative therapies. Ideally, your doctor can keep an open mind and help you evaluate alternative therapies that interest you.


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THE BOTTOM LINE
Most people with HIV use some kind of alternative or complementary therapy. Some alternative therapies can be dangerous. Others are safe to use. Some have been carefully studied and can improve your health.

It is difficult to study alternative therapies. Find out as much as you can before you start using an alternative therapy. Let your doctor know about the therapies you are using.



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Revised March 29, 2001



WHAT IS ACUPUNCTURE?
Acupuncture is a healing technique used in traditional Chinese medicine. Very thin needles are used to stimulate specific points in the body. These points lie on energy pathways called "meridians." Acupuncture treatments are designed to improve the flow and balance of energy along these meridians.

Traditional Chinese medicine is at least 2,500 years old. It views the human body as a system of energy flows. When these flows are balanced, the body is healthy. Practitioners take their patients' pulses and examine their tongues to diagnose energy imbalances. In Chinese medicine, pulses can be taken at three positions on each wrist, and at three depths at each position.

Illness is not defined by symptoms or the name of a disease like "HIV infection." Instead, a practitioner of Chinese medicine will talk about energy imbalances. The language can sound very strange, like "yin deficiency" or "liver heat rising." The Chinese words yin and yang refer to opposing energies that should be in balance, and Qi (pronounced "chee") can be roughly translated as energy or life force.

In traditional Chinese medicine, there are many ways to improve the balance of the body's energy flows. The most common techniques used in the western world are exercise techniques such as Qigong or Tai Chi, acupuncture, and herbalism. Fact Sheet 704 has more information on Chinese herbalism.

Many practitioners of Chinese medicine specialize in either acupuncture or herbalism. Very few use both methods.


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WHY DO PEOPLE WITH HIV USE ACUPUNCTURE?
Because acupuncture deals with energy balance, there are not specific acupuncture points used to treat HIV. Instead, your acupuncturist will use your pulses and will probably look at your tongue to find out how your energy flows are out of balance.

Acupuncture does not cure HIV infection. Many people, however, believe that it has helped them improve their overall energy, or deal with the side effects of antiviral medications. Some people have used acupuncture to reduce the stomach upset or diarrhea caused by their medications. Other people find that it helps ease the pain caused by neuropathy (See Fact Sheet 553 for more information on neuropathy).


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HOW IS ACUPUNCTURE USED?
Based on your energy imbalances, your acupuncturist will select acupuncture points to stimulate. You will lie on a table, either on your stomach or on your back. Needles will be inserted at the selected points. You may feel a little pain, tingling or numbness as the needles are inserted. The needles are left in place for up to 30 or 45 minutes, depending on what the acupuncture is intended to accomplish. During that time, many people fall asleep.

You might receive additional treatments during acupuncture to increase the flow of energy:

The needles might be stimulated with a very mild electric current (electroacupuncture)
Moxa is soft material prepared from dried mugwort, an herb. Moxa may be put on the top end of acupuncture needles or (rarely) right on the skin. Moxa is burned to provide penetrating heat. This is called moxibustion.
Round glass cups can be used to create suction over specific points (cupping). The suction stimulates the flow of energy. If the cups are left on for a long time they can leave a red mark.
Some practitioners use small beads or tiny needles held in place with adhesive to keep pressure on an acupuncture point for a few days.



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WHAT ARE THE RISKS AND SIDE EFFECTS?
Some people feel slight pain, numbness or tingling when acupuncture needles are inserted. In rare cases, people will feel dizzy or nauseated during acupuncture. There may be a drop of blood when a needle is removed. Acupuncture has far fewer side effects than most western medicines.

You should not go for an acupuncture treatment if you have had any alcoholic beverage within an hour, or if you are using any recreational drugs.

Be sure your acupuncturist knows if you are pregnant. Some acupuncture points should not be stimulated during pregnancy.


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HOW DO WE KNOW IT WORKS?
Research on acupuncture shows that it is effective in treating some kinds of pain and nausea. This led the National Institutes of Health in 1997 to issue a statement supporting the value of acupuncture for certain conditions. The World Health Organization lists over 40 conditions that may be helped by acupuncture.

A recent study on acupuncture to relieve the pain of neuropathy did not show any benefits. However, the study design has been criticized for using the same acupuncture points for everyone in the study, and for using fake acupuncture points for comparison. Many people with neuropathy believe that acupuncture has helped them.



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Revised May 24, 2001



WHAT IS HERBALISM?
Healers in many different health traditions use herbs. This fact sheet discusses herbs as a part of traditional Chinese medicine.

Traditional Chinese medicine is at least 2,500 years old. It views the human body as a system of energy flows. When these flows are balanced, the body is healthy. Practitioners take their patients' pulses and examine their tongues to diagnose energy imbalances. In Chinese medicine, pulses can be taken at three positions on each wrist, and at three depths at each position.

Illness is not defined by symptoms or the name of a disease like "HIV infection." Instead, a practitioner of Chinese medicine will talk about energy imbalances. The language can sound very strange, like "yin deficiency" or "liver heat rising." The Chinese words yin and yang refer to opposing energies that should be in balance, and Qi (pronounced "chee") can be roughly translated as energy or life force.

In traditional Chinese medicine, there are many ways to improve the balance of the body's energy flows. The most common techniques used in the western world are exercise techniques such as Qigong or Tai Chi, acupuncture, and herbalism. Fact Sheet 703 has more information on Chinese acupuncture.

Many practitioners of Chinese medicine specialize in either acupuncture or herbalism. Very few use both methods.


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WHY DO PEOPLE WITH HIV USE CHINESE HERBALISM?
Chinese herbs do not cure HIV infection. Many people, however, believe that the herbs have helped them improve their overall energy, or deal with the side effects of antiviral medications. Some people have used herbs to reduce the upset stomach or diarrhea caused by their medications.

In general, an herbalist makes up a personalized mixture for each patient, based on that person's particular energy flows and imbalances. However, some practitioners of Chinese medicine have noticed a consistent "toxic heat" pattern of energy imbalances in people with advanced HIV disease. Due to Chinese medicine's emphasis on long life and immune enhancement, they feel that some herbal preparations will probably help anybody with HIV.


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HOW ARE CHINESE HERBS USED?
Based on your energy imbalances, your herbalist will prescribe a combination of herbs for you to use. The Chinese meaning of herbs can include various parts of plants as well as minerals and animal parts. The herbs can come in several forms:

"Loose" or "raw" herbs: you get a bag of various dried pieces of roots, bark, leaves, seeds, powders, and other items. These are usually boiled and you drink the "tea." This is considered the most potent form for herbs, but it can be difficult to prepare them.
Powdered herbs: Dried herbs are ground into a powder. The powder might be mixed into water to drink, or taken in a capsule.
Tinctures: Dried herbs are prepared in a mixture of water and alcohol. You drink a dose of the tincture.
Patent medicines: Some of the most common combinations of herbs are available in prepared form as pills, capsules, creams, or other forms. There is usually very little or no labeling on these medicines except in Chinese.
Chinese herbs are prescribed to correct energy imbalances. You might feel better, or symptoms might disappear, but the best way to know if it's time to stop or change the herbs you are taking is to consult with your herbalist.


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WHAT ARE THE SIDE EFFECTS?
Most herbs used in Chinese medicine are safe at a wide range of dosages. However, some may be toxic at very high doses, or might not be safe to use during pregnancy. The safest way to use Chinese herbs is according to the instructions of a trained herbalist. Be sure to tell your herbalist and your doctor if you think the herbs are causing diarrhea, headaches, or any other problems.


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HOW DO HERBS INTERACT WITH OTHER THERAPIES?
Almost no controlled research has been done on specific interactions between Chinese herbs and other therapies, including antiviral medications. There is no information on any dangerous interactions.

It is always a good idea to let every practitioner on your health care team know about all of the therapies you are using. In some cases, a western medicine and Chinese herbs might have a similar effect and combining them would be too much. For example, it might not be a good idea to use Chinese herbs that help calm you down and sleeping pills at the same time.


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HOW DO WE KNOW IT WORKS?
There are several scientific journals that present research on the health benefits of Chinese herbs. However, almost all of them are published in China.

Studies on treating HIV with Chinese herbs have had mixed results. However, these studies usually studied Chinese herbs as antiviral treatments. More recently, herbs are being combined with antiviral medications. Some herbalists believe that the best use of herbs will be to help deal with the side effects of strong antiviral drugs, and to generally strengthen the immune system.



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Reviewed May 24, 2001

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