Subject: Syphilis and AIDS Date: Published: April 1989 [from GAY COMMUNITY NEWS, Vol. 16, No. 37, April 2 - 8, 1989] Syphilis and AIDS: What's the Connection? by John Dooley After various unsuccessful treatments for AIDS and a nearly fatal bout with pneumocystis carinii pneumonia (PCP), John has been healthy for more than a year. Teddy, who suffered from Kaposi's Sarcoma (KS) lesions and exhaustion is now energetic and his lesions are stable. And the rash that covered Michael Smith's body, which "nobody had been able to do anything about that wasn't severely invasive or perhaps even life-threatening," has not resurfaced since mid-1988. John, Teddy and Smith have undergone an inexpensive and non-toxic AIDS therapy that first boosts the immune system and then treats illnesses present in the body. One of these illnesses is syphilis, which some members of the medical community consider a major undiagnosed factor in AIDS. In the face of a losing battle against AIDS, Salvatore J. Catapano's immune-boosting typhoid vaccine therapy offers a ray of hope. When Catapano set up a laboratory in the basement of his home in Valley Stream, Long Island, in 1962, he was fulfilling a promise he made to himself to study cancer. His father died of threat cancer in 1926, and two decades later his brother and sister were also dead. His brother suffered from pancreatic caner, his sister from cancer of the cervix. Catapano eventually focused on trying to conquer the disease by boosting the immune system. He tested various vaccines but not until 1971 did he discover the tremendous immune-stimulating properties of typhoid vaccine. This discovery motivated Catapano to seek a patient for an immune-stimulating cancer treatment. After two years of favorable trials at the National Cancer Institute, unsuccessful negotiations at pharmaceutical companies, and countless phone calls and letters to government officials, Catapano decided to refocus his patent application. Finally, on Dec. 5, 1987, he received a patent to treat not cancer, but AIDS. Patent No. 4,711,876 states, in part, "It has been found that a complete immunization and remission of a person afflicted with AIDS may be achieved by the administration of typhoid vaccine with no observed toxicity." People involved in Catapano's patent research, which started in October 1986, were diagnosed with KS, extreme fatigue, weight loss and other conditions. The severity of KS lesions in some patients gradually improved, and no patient developed new lesions. After approximately 10 weeks of treatment, "most patients were capable of performing normal everyday tasks, including work," and they gained weight, Catapano said. The results with KS did vary greatly, explained Miguel Cima, a doctor from Rockville Center, N. Y. Cima, who worked on the study with Catapano, said "IT's not so simple with KS, it's not black and white." But, he added, even if the typhoid vaccine doesn't clear up the lesions, it can lessen their severity and "improve quality of life." Besides, there is definite improvement in some people, he said. Results with weight loss and fatigue were more promising -- all participants in the patent study have maintained their weight and energy levels, according to Catapano. In addition, the count of white blood cells -- part of the body's defense mechanism -- increased for the group, as did the percentage of white blood cells called lymphocytes, which are instrumental in fighting infection or invasion by bacteria. SYPHILIS -- AN UNDIAGNOSED FACTOR IN PWA'S? In the early days of his typhoid vaccine research, Catapano learned that before the advent of penicillin in the early 1940's, the vaccine had been used to treat another disease. That disease was syphilis. While other medical practitioners attribute KS, PCP and other maladies in PWA's to infection with human immunodeficiency virus (HIV), Catapano says that in many cases the illnesses are identical to syphilis ailments he treated during his four decades as a medical technologist in the Navy and for the U.S. Public Health Service. Catapano does not stand alone in his believe that symptoms of syphilis, known as "medicine's great masquerader," are often mistaken for those of HIV infection. Fifty doctors are licensed to use his treatment procedure, or protocol, in the United States, and are treating more than 300 patients. A handful of other medical practitioners in this country and Europe are working on similar theories. Valentine Birds, a doctor who has been using the protocol in North Hollywood, Calif., since June, is "very convinced that syphilis is a major factor in AIDS. I can't say it's the exclusive causative factor, he said, "but it's a key factor and one that we must consider as maybe a main causative factor." Thirty to 40 percent of Bird's AIDS patients test positive for when he first sees them, but after being on the typhoid protocol the percentage jumps to 60 or 70. "This is telling me that they have hidden syphilis," Birds said. "A lot of my patients come in with skin rashes they've had for a long time. We treat them with the typhoid, and then we treat their syphilis and the rashes go away." Most of birds AIDS patients receiving the typhoid treatment end up being treated for syphilis. In fact, some of them want to be treated for syphilis even though their tests are negative. It's interesting," he said, "those people have symptoms that clear up. So there must be something I'm missing in this syphilis diagnosis." As Catapano explains it, the blood tests commonly used to detect syphilis were not manufactured to be used for people with suppressed immune systems. These tests measure the body's ability to produce antibodies to the disease, they do not measure the present of the bacterial organism -- Treponema pallidum -- that causes the disease. Unless the immune system is in a reasonably normal functioning state, it will not produce antibodies to the treponema; and in diseases such as AIDS, the immune system is not functioning properly. It is possible for people to test positive for syphilis after their immune systems have been stimulated by the typhoid vaccine, Catapano said, but many other people may have undetected syphilis. Evidence cited to support the theory that syphilis may be a major undetected factor in AIDS includes an autopsy performed on 20 PWAs -- all 20 were found to be infected with syphilis, even though only five of them were diagnosed with it while alive. In addition, "everything that shows up in AIDS and ARC shows up in late-staging syphilis," said Joan McKenna, director of the Basis Project, an in-depth syphilis screening program developed by the Institute for Thermobaric Studies in Berkeley, Calif. THE DARKER SIDE OF PENICILLIN Syphilis is divided into several stages. The first stage -- primary -- is associated with an ulceration lesion called a chancre. Chancres are present at the point where T. pallidum enters the body. "If the chancre is in a spot that's not noticeable, it may go undetected because it's a painless lesion," said Dr. Jack Moye, director of the Massachusetts Department of Public Health's Sexually Transmitted Disease Program. "Then the patient may have weeks or months of no symptoms at all as the syphilis organism is travelling by the bloodstream to other parts of the body." Next is the secondary stage, "a generalized illness where people feel sick all over. They have a temperature, they feel like they have the flu," Moye said. This stage is also associated with swollen glands and a body rash. "People usually seek medical attention," Moye continued, "but if they don't [the symptoms] go away by themselves and they may have months or years of being asymptomatic before the stage of late syphilis, the stage associated with severe complications. It can affect the organ system of the body." The syphilis that Catapano and other AIDS-syphilis theorists are especially concerned about may develop when repeated treponema infections are not treated, or, more commonly, are mistreated with penicillin. Before the advent of penicillin, syphilis was taken much more seriously than it is today, according to Robert Mitchell, author of "Syphilis is AIDS: A Military Masterpiece," which is yet to be published. "Then syphilis almost universally disappeared from medical literature," he said "When penicillin came out everyone assumed that it was a cure for the disease and it went down to a chapter in most books. Nowadays, you're lucky to find even 10 pages. The standard dosage 2.4 million units of benzathine penicillin prescribed for syphilis resolved symptoms of the disease, and physicians assumed they were killing the organism. This treatment, however, may never have been effective, according to McKenna. The antibiotics may have suppressed the expression of the disease without curing it, she explained. In Europe, when people have syphilis infection they are treated very aggressively and their medical history is flagged, McKenna said. She recommends similar treatments for primary syphilis, including aqueous penicillin, and retreatment and reevaluation for two years on a regular basis. The person's medical history should be flagged for 50 years, so every doctor who sees a patient "must consider that what he's seeing could be recurring syphilis." Kenneth H. Mayer, a doctor and research at the lesbian and gay-focused Fenway Community Health Center in Boston and associate professor at Brown University, agrees that the standard U.S. treatment for syphilis is inadequate. "2.4 million units of penicillin is not good enough. There's a real good chance that they haven't gotten all of the syphilis," he said. In addition, this dosage is not enough to pass the blood-brain barrier and attack the T. pallidum that may be present in the brain in the late stages of syphilis. The U.S. Department of Health's Centers for Disease Control (CDC) has also recognized the problem of misdiagnosis and mistreatment of syphilis. In the Oct. 7, 1988 issue of its Morbidity and Mortality Weekly Report, the CDC published a report that included recommendations for diagnosing and treating syphilis in HIV-infected people. The CDC indicated that tests for syphilis are not accurate for people "coinfected with HIV." Recommendations included administration of syphilis tests for Hiv- infected people, and in cases where syphilis antibody tests are negative, the use of tests that directly detect T. pallidum. Also, in a January 1987 editorial in the Journal of American Medicine, Dr. Mary Guinan, assistant director of science for the CDC, said the CDC had never evaluated the effectiveness of its recommended penicillin dosage. The editorial also acknowledged that the treatment may not be sufficient for HIV-infected people. Penicillin, "that thing that was golden, like an angel from God," may be showing its darker side, Catapano said. "[Doctors have] overabused it so much that it's not going to work. It's losing its punch." After the typhoid vaccine stimulates the immune system in the first stage of his protocol, Catapano uses penicillin to treat opportunistic infections. This immune stimulation is critical to the antibiotic's effectiveness, he said. "When you use penicillin alone its going to bomb out. And acquired immune deficiency syndrome makes it twice as hard to work." According to author Mitchell, "If you get repeated T. pallidum infections and you have compounding factors like antibiotics that are only treating symptoms, you can get this rampaging version of the syphilis that follows no rules and can kill you within a year or two." Among gay men, syphilis was epidemic before the age of safe sex. According to McKenna, there were days when the San Francisco Health Department estimated that 80 to 90 percent of the population had had syphilis. Long before AIDS appeared, staff at the Fenway Community Health Center were telling people to get tested for syphilis two to four times a year if they were sexually active, "because it is so insidious," Mayer said. "There were a lot of people who were not attuned to sexual health issues, and they may have had syphilis in their bodies for 10 to 15 years and just be discovering it now. It's hard to say." SUCCESS WITH THE VACCINE According to McKenna, an unrecognized epidemic of syphilis among gay men today "is the top of an iceberg" in relation to syphilis in this country. "We have to start doing something about it now." Catapano agrees. While he does not claim that his protocol is a cure for AIDS or syphilis, he thinks it can help PWA's and people with other immune-related illnesses stay healthy. By stimulating their immune systems, it helps them fight off opportunistic infections, he said. "What we're hearing at HEAL [Health Education AIDS Liaison] is that the most resounding success in treating AIDS and PWA's with syphilis is going on with Catapano," said Gene Fedorko. Fedorko is the president of the New York-based HEAL, which has been providing information and support for alternative and holistic approaches to AIDS and related conditions since 1982. Birds, who has treated about 110 patients with typhoid vaccine, is also having success. "Trying to be conservative, about 60 percent of them have clinical improvements," he said. "They feel better, they look better, their laboratory tests are showing improvement.: The remaining patients don't respond for a variety of reasons, he said. Many of them are simply "too far gone" in the process of the disease. He added that immune-suppressing drugs, especially the highly toxic AZT, inhibit this or any other treatment. I'm convinced you got on AZT to die," he said. 'Typhoid, on the other hand, is a positive situation.... We're using it as a holding pattern until something better comes along." Terry Pulse, of Dallas, was the first doctor licensed to use Catapano's treatment. He received the license on Jan.4, 1988. He first 13 patients that Pulse treated with the vaccine did not respond well, "because most of them were terminal KS patients," he said. Others had been treated with chemotherapy that had "knocked out their immune systems." Since then, the criteria for the protocol have been widened to include people with AIDS-related complex (ARC). "Generally, the results are very good now," he said. WHERE'S THE MEDICAL ESTABLISHMENT Despite the success of doctors using the protocol and despite Catapano's claim that 60 percent of the more than 300 people has has treated are "doing well," the medical establishment -- including government health agencies, medical schools, hospitals and most doctors, has generally not responded favorably to his protocol. People who see a link between AIDS and syphilis are waiting for the medical establishment "to wake up and start asking questions," McKenna said. "The government said it doesn't get involved until there's a national issue, when more states and health departments are moving on this. We started talking to them about it in 1984." It's difficult to get the U.S. Public Health Department involved because "the ramifications are horrendous," Mitchell explained. If the government health agencies start doing research and realize they've been wrong about syphilis since the 1940's, "they could be looking at national class-action lawsuits." But government liability would not stop with syphilis, according to Mitchell. If health agencies are wrong about the syphilis-AIDS connection, they also have to admit that billions of dollars have been wasted and thousands of deaths could have been prevented. Drug companies have billions of dollars at stake, too, HEAL's Fedorko said. Burroughs Wellcome, for example, made $176 million last year on the sale of AZT. Originally developed as a chemotherapeutic agent for cancer, AZT failed to receive FDA approval in the late '60s because it was too toxic. Now it's being used as a treatment for AIDS. "When there's billions of dollars involved, you have of really start questioning people's motives," Fedorko said. Another aspect of the economics concerns penicillin, which could help combat syphilis and opportunistic infections in PWA's. Penicillin is generic, and it is very inexpensive. Typhoid vaccine also costs very little. "Just figure it out," Catapano said. "Where are the pharmaceutical companies going to make money?" Money, or lack of it, is also an issue for researchers who do not share the medical establishment's views. Most research is connected to large institutions, where little dissent is tolerated when it comes to questioning what causes AIDS, McKenna said. There are too many reputations riding on the perceived competence of their methods, she added. Catapano also criticizes the tendency in the medical community "to go according to the establishment...." The doctors are not questioning anything the government or drug companies are doing." He noted that a leading French research institute, which he declined to name, is interested in examining his protocol. Going according to the establishment is not a new problem, the AIDS-syphilis theorists say. Since Louis Pasteur discovered bacteria, Western medical science has clung to the idea that single agents are the cause of infectious diseases. When AIDS came along "the percentage of PWA's with HIV was so high that there are understandable reasons why well-intentioned people could have focused on HIV as a prime candidate," said Bob Lederer, co-founder and co-chair of ACT UP/New York's Alternative and Holistic Treatment Subcommittee. There was also "a bureaucratic predisposition toward retrovirus research" as a result of the war on cancer's focus on retroviruses in the '70s, Lederer said, "and that bias has influenced research priorities." Lederer predicts that at some point "despite all the vested interests that argue against admitting the syphilis connection, they'll have to balance that against what they're going to lose if they don't take action." THE DATA CONTROVERSY Doctors who do not embrace Catapano's theory often cite the lack of data to support his claims. Anecdotal reports of successful treatments are not enough, they say. Although some would like to know more about the treatment, they say they need to see the data "written in a reputable medical journal." "for me to evaluate his protocol, I would have to see the evidence that it has been looked at in a randomized, placebo-controlled manner," said Robert Rolff, medical epidemiologist in the CDC's Sexually Transmitted Disease Division. AIDS activists say there is no reason to wait. It has been more than two years since Catapano treated his first patients, they say, and most of them are still doing well. They admit that Catapano would be serving the interests of the medical community by publishing his data, but disagree that studies should be completed before the protocol is accepted, at least on a conditional basis. It is non-toxic, they add, and the health of Catapano's patients is sufficient evidence to use the protocol while more elaborate studies are conducted. Catapano plans to publish data with a group of doctors using his protocol in May or June, he said. Some doctors also claim that the typhoid vaccine, as an immune booster, might cause HIV to replicate faster. "HIV lies latent for years, they it gets kicked up. We don't understand if that's because of a herpes infection, stress or other stimuli," Mayer said. Until now, when immune-boosting drugs have been given without something to suppress the virus, they have not been successful in treating people with AIDS, he added. There is no data, however, that substantiates this relationship between typhoid vaccine and HIV, according to the PWA Coalition, in New York. Although most members of the medical establishment do not believe that syphilis is a major factor in AIDS, they say proponents of this theory may have played a vital role in combating sexually transmitted disease. "They may have helped to focus attention on the problem of treatable disease in patients with HIV infection going undetected," said Moye. There is much concern about syphilis altering its course in people coinfected with HIV, he added. A number of case reports demonstrate that syphilis is unusually severe, rapid and refractory to treatment in HIV-infected people. Mayer, too, warned of the "very strange ways and severe manifestation s of syphilis" in the HIV-positive population. "There are well- documented articles now suggesting that the kinds of syphilis that weren't seen since before the antibiotic era have been seen in people with AIDS. It's because syphilis, like a lot of other infectious agents, can be more virulent when a person's immune system is suppressed." Concern over HIV and syphilis infection has prompted two studies at the CDC. One will try to determine whether syphilis is more severe in people infected with HIV, and it will examine the effectiveness of various treatments and diagnostic tests in people infected with HIV. "The evidence is reasonably persuasive that it is a cofactor for acquiring HIV infection because of the genital ulceration," Rolff said. Moye explained that since 1a and syphilis are sexually transmitted diseases, it would be reasonable to assume that people could be infected with both, especially because the genital ulceration (chancre) characteristic of syphilis presents a portal of entry for HIV> Moye also points out that both diseases have been extremely common among gay men. Like most members of the medical establishment, he considers this relationship coincidental. As Rolff put it, "It's hard to rule out whether genital ulceration may have been a cofactor, but I think it's just as likely, maybe more likely, that the same people who are at risk of acquiring syphilis are at high risk of getting HIV. Due to the high risk of coinfection, and the possible rapid progression and severe complications of syphilis in HIV-infected people, Moye cautions patients and medical providers to be aware of the manifestations of syphilis. In addition, he said, "IF I were HIV-infected, I would be tested for diseases like syphilis and tuberculosis, which can be treated and even cured if they're treated early enough. TEDDY, JOHN AND MICHAEL The fist person to treated with Catapano's typhoid vaccine was Teddy, in October 1986. In addition to KS lesions and exhaustion, he suffered from chronic sore throat, swollen glands and thrush, (a mouth disease caused by a fungus). After six weeks on the protocol, all of these conditions, except KS, were gone. "Sal's typhoid vaccine works," Teddy said. "IF you get to him before you've taken AZT and the rest, it can build your immune system. Otherwise, it's very hard." When John decided to try the typhoid vaccine protocol in January 1988, he was desperate. He had undergone an AIDS treatment that did not work for him, and "felt like if the vaccine didn't help, it couldn't hurt." None of m blood was in the normal range." How, "I have no doubt whatsoever that it has saved my life," he said John's blood work is now in the normal range, except for his T cells, which are still low. "Everything else has turned around, which is pretty amazing." he said Currently on a maintenance program with Catapano, John has gained 31 pounds, and except for a minor bout with strep throat, occasional episodes of fatigue and a skin condition on his elbows, he said he feels great. He's had no major opportunistic problems since he began the protocol. The most serious opportunistic infection that Michael Smith has experienced wince his diagnosis with AIDS in July 1987 is PCP, also known in syphilis as white lung pneumonia. Smith, a stockbroker and AIDS activist, said his history of syphilis "is really quite astounding." He contracted syphilis for the first time around 1963, when he was 19. In 1972 he was again diagnosed with primary syphilis and given the standard dosage of benzathine penicillin. In 1974 he also "came up positive" for primary syphilis. Over the next three years, Smith said, he visited a clinic two more times and was diagnosed with early latent syphilis, "which meant syphilis had been in my body for a while and was still there. I was treated in the same way." Since 1977, Smith's syphilis has been in hiding -- he has not been able to produce a reactive blood test result for syphilis. "I think I was undoubtedly running around with syphilis but my immune system was going to hell," he said, "and I suspect somewhere around '77 I was exposed to HIV if it is a separate thing." When Smith went to New York in February 1988 to give a lecture on AIDS and syphilis, he met about a dozen Catapano patients who "raved about it," he said "I decided to take the typhoid vaccine because I had the body rash. I had had it for four months and nobody had been able to do anything about it.... Catapano said it looked like secondary syphilis. "I went on the Catapano protocol in February '88. It took a while -- about three months after that, the rash was in compete remission, and it stayed that way," Smith added. "If you are dying and somebody tells you there's a possibility that typhoid can delay your death or that massive doses of penicillin can delay your death, do you want to give it a try or do you want to take AZT and know you're going to die? I've always said I would do anything provided it shows promise and it's non-invasive. And we know how penicillin works," Smith said "I'm not going to keel over and die."