HBOT reduces plasma TNF and HIV viremia, which are directly correlated with endothelial cell wall damage in HIV-infected patients. It increases peripheral and microvascular cell oxygenation as well as increasing the functional capabilities of cell membranes to absorb metabolic lipids. Re-absorption of lipids improves the patient’s nutritional status. HBOT reduces plaque buildup and occlusion to the vessels. It helps to maintain neurologic function and reduction of triglyceride levels.
Microvascular and macrovascular peripheral insufficiency also occur in various other acute infectious diseases including syphilis, diabetes, coronary artery disease and chronic obstructive pulmonary disease (COPD).
Positive results are achieved after two weeks of therapy three times per week. The first symptom relieved is fatigue, then an increase in exercise is seen, as well as warmth of the extremities and reduced pain in the legs and feet. Normal sleep habits are noted. Symptom relief is sustained for over 72 hours and is then seen to dramatically decline back to baseline.
In the healthy adult, oxygen saturations are 98-100% without HBOT. In patients with AIDS baselines of 90 percent are common. Hypoxia occurs with HIV and herpetic infections that attack the circulatory and neurovascular systems. Dermatologic disorders such as recurring folliculitis are decreased with HBOT and this improves the physical appearance and self-esteem of the patient. There is improved endurance and a reduction of pain.
In the studies reported by Reillo, all patients responded within one month. Treatments were three times per week. All the patients treated for acute peripheral vascular insufficiency also benefited neurologically with consistent therapy. There was no occurrence of dementia even though there were CD4 cell counts of less than 50. As when treating acute diabetic peripheral vascular insufficiency with HBOT, perfusion to the extremities increased. This has been cost-effective and has allowed patients to maintain normal daily activities and employment.
According to K. K. Jain, “There is no doubt that HBO helps the secondary infections in AIDS patients and thus improves their condition and reduces the mortality. However, the direct effect in eradicating AIDS remains to be proven.”69 He thinks that there are so many potent and effective chemotherapeutic agents available and the molecular diagnostics that can estimate viral loads. Jain thinks that HBO has a definite place as an adjunct to antimicrobial drugs for treatment of secondary infection. Any HBO claims have to be tested against other drug regimens as controls. As usual, more studies are needed. Jain reports that HBOT pressures up to 2.5 ATA have an immune stimulating effect and bring about an increase in the number of lymphocytes.
Jain critiques the study reported by Reillo where she claims that HIV viral load was decreased in the infected cells when treated with HBOT. The results of this study were used to support the theory that HBOT had an antiviral effect, but these observations have not been reproduced by other researchers.
Jain suggested the use of HBOT in HIV in 1987 to treat opportunistic infections and stimulate the immune system. Another use that he noted is that free radicals generated by HBOT and accelerated by mild hyperthermia (38.5 degrees C.) can penetrate the lipid covering of the virus and kill it. The toxic effects of free radicals on normal cells can be blocked by the use of Mg2+, a cell membrane protector.70
Both medical practitioners unfamiliar with HBOT and professionals skilled in HBOT but unfamiliar with AIDS have been critical of the use of HBOT in the management of AIDS.
The lack of use of HBOT in managing AIDS is primarily based on a lack of understanding. AIDS is not a specific disease, but rather a complex syndrome with various manifestations. It is made up of a multitude of opportunistic infections, diseases, and physiologic complications. Regardless of the underlying disorder, HBOT has well documented evidence supporting its use in many of these.
“Many autoimmune, neurologic, and viral diseases share the same manifestations as AIDS. Peripheral vascular and neurovascular abnormalities are shared by MS, AIDS, and diabetes.”71 In the U.S., the majority of hyperbaric chambers are hospital-based. Freestanding and private clinics are not as commonplace, but they often offer treatment to patients with a broader spectrum of diseases.
In order to be treated with HBOT for conditions related to AIDS, a patient needs to be referred to a facility by a physician, because O2 is a drug, is regulated and must be prescribed. The specific diagnosis is important, since, because AIDS is not a disease, HBOT is therefore not covered by insurance. However, many insurance carriers do reimburse for HBOT in treating complications related to diseases.
In situations where insurance companies are unfamiliar with HBOT letters of medical necessity from the attending physician may facilitate coverage for treatment. Medical referral to the director of the facility will determine if the facility is willing to care for the patient with AIDS. It is a new use, and there is still a relative lack of information and education. For optimum care, this author recommends that the patient be referred to a facility that is familiar with AIDS and its complications for optimum care.
69Jain, 2004, 142.