Reports: Bud’s Therapy and Other Cats

1. Introduction

2. Criteria for Inclusion

3. Index of Medications and Supplements

4. Reports

5. Natural Interferon Trials

1. Introduction

A number of people have written in the last few years asking about applying agents described in Bud’s FIV Therapy to their cats or simply reporting that they already had. The purpose of this venue is to describe what some of them (those who stayed in touch) have done and what they have reported to date. If anyone reading these words is either planning on using agents described on the Guidelines and Medications and Supplements pages or already has used them, I would be glad to create a report from forwarded information and include it with those that follow. As many relevant details as possible are encouraged. This is an opportunity to help someone else’s cat benefit from your experience and to further the cause of discovering effective therapies for treatment of FIV infection.

The order of the reports is chronological, reflecting when the therapeutic program began. Medications and supplements covered on the Guidelines and/or Medications and Supplements pages are highlighted in bold print. I would be happy to arrange contact in the event that anyone wishes to communicate with someone whose efforts are reported on for further details.

2. Criteria for Inclusion

The medications and/or supplements reported on should be of potential value to the treatment of FIV, not just to treating some secondary disease and not just to maintaining the general well-being of any cat.

Use of cyproheptadine, for instance, would not qualify because it has no inherent connection to the treatment of FIV; it will treat all appetite depression. Use of, say, lactoferrin would, for, although lactoferrin is of particular use against stomatitis (a common FIV-associated problem), it has potential usefulness peculiar to treatment of FIV. Substantial dosage of Vitamin C would qualify, since this is particularly indicated for FIV; small dosages (say 10mg daily) wouldn’t, since these are routine dosages appropriate to any cat and any situation.

The medications and/or supplements you report on should have been used for a minimum of one month, unless you are reporting on an adverse reaction that necessitated ceasing use.

There must be some report of outcome, even if there was no change at all in health status. Simply reporting that something has been or will be used is not helpful.

3. Index of Medications and Supplements

♦ Click on Report Number

♦ Use Back Button to return to Index

Alpha Lipoic Acid [ALA]-----------3), 4), 5)

Carnitine-----------------------------2), 3), 15), 17)

CoQ 10------------------------------2), 3), 8), 17)

Curcumin [Turmeric]---------------5)

DMG----------------------------------16), 17)

Emtricitabine [FTC]----------------4)

Feline Omega Interferon----------1), 4), 7), 9), 16)

Grape Seed--------------------------3)

Green Tea---------------------------3)

Iodine---------------------------------6)

Lactoferrin---------------------------3), 4), 7), 10), 12), 15), 17)

Lamivudine [3TC]-------------------8)

Licorice [Glycyrrhizin]--------------2), 3), 5)

LTCI*---------------------------------9), 11), 13), 14) *Lymphocyte T Cell Immunomodulator

Melatonin----------------------------3)

Moducare [Beta-Sitosterol/-in]---2), 3), 15), 16)

N-Acetylcysteine [NAC]-----------3), 4), 5), 8)

Niacinamide-------------------------4), 7), 8)

Olive Leaf---------------------------4), 5), 7), 17)

Prednisolone (low dose)----------4), 7)

Prunella-----------------------------3), 5)

SPV30 [Boxwood]-----------------5)

Selenium----------------------------4)

Tenofovir [TDF]--------------------4), 8)

Thymus Peptide-------------------2), 3), 5)

Vitamin B12------------------------2), 3), 8)

Vitamin E---------------------------2), 3), 4), 5), 15), 16)

Vitamin C---------------------------2), 3), 4), 7)

Note: Some cats whose case histories appear on the Natural Interferon Trials page have used or are using some of the above medications or supplements. They appear in bold print there, as they do here.

4. Reports

Clinical staging is a matter of some uncertainty with FIV, especially when available information varies among a number of individual owners and when no single knowledgeable and experienced person is making the clinical judgments. For purposes of this document, recurrent or refractory pathologies characteristic of cats with FIV infection or constellations of problems associated with FIV are assumed to justify the label “ARC” (AIDS-Related Complex). Cats who don’t meet these criteria but who have shown isolated, resolving problems in which FIV probably plays a role are simply classified as Symptomatic. Cats whose blood work and/or clinical health suggest deep immune suppression are categorized as “AIDS.”

Last Updated 12 July 2010

1)

Cat. Eric [m], born c.1998 No Further Updates

Owner. Sue Taft, U.K.

Disease Status. ARC

History. Eric is a rescue cat. He had been tested for FIV in 2002 and found to be negative. Subsequently, he developed stomatitis and gingivitis, necessitating removal of all teeth. Retesting twice in 2004 by Elisa produced a finding of FIV positive. The oral disease caused severe pain, which in turn caused poor eating and significant weight loss with a poor quality of life. Attempts to treat Eric's oral disease with Metacam resulted in anemia, and treatment had to be broken off.

Therapy. In mid- 2004 Eric began a series of injections of Feline Omega Interferon. The protocol was a series of five injections every other day, which was then repeated several weeks later, and repeated yet again several months after that. Three weeks after the final injection of the third series he began a maintenance program of one injection every three weeks.

Outcomes. Eric's oral disease was significantly improved prior to completing his inital 3 x 5 injection series. Eventually, his symptoms cleared entirely. Since 2005 he has been a healthy cat. He has regained all of the weight lost as a result of his oral disease and has actually added weight. He has had periodic minor relapses, most recently in late 2006, but antibiotics (clindamycin) quickly eliminated the problem. In March 2007 veterinary visit, the owner reported, “His mouth is perfect (vets words not mine), no inflammation or redness whatsoever.” However, in May a severe outbreak of calici virus, including the characteristic ulceration of the tongue, occurred. This outbreak resolved without special measures in June 2007. In early November 2007, because of some episodes of coughing, Eric got a a veterinary exam with x-ray, which detected lung abnormalities. Pneumonia and tumor were considered possible diagnoses. However, by mid-November antibiotics had resolved the situation (assumed to have been pneumonia). Eric began to show symptoms of illness in February 2008. An ultrasound showed an enlarged liver as well as other abnormalities. The diagnosis was cancer, with a large tumor in his liver. Anemia and weakness, then anorexia, followed progressive bleeding into the abdomen. Eric was euthanized on the last day of March 2008.

Discussion. Even with full mouth extraction of teeth, relapse is the fate of many cats with severe gingivostomatitis. Feline omega interferon was a very effective therapeutic agent over a long span of time in Eric’s case, considerably raising his quality of life. Since the precise nature of Eric’s liver cancer is unknown, no conclusions about a possible relationship to his FIV-status or long-term use of interferon. Various cancers do have a strong association with FIV infection.

2)

Cat. Max [m]and Fifi [f], born c. 1996 No Further Updates

Owner. Kerry Traeger, Australia

Disease Status. Asymptomatic

History. Max and Fifi have been largely indoor cats, but do go outdoors occasionally. For three years they shared their household with a stray adoptee named Fabian, who was diagnosed with FIV and subsequently died and who was the presumed source of infection, although the three cats were on friendly terms. This may be one of those cases of “benign transmission” that cannot be readily explained. The owners feel that they would have noticed bite wounds. Blood tests (Elisa), however, showed both to be FIV+.

Therapy. Beginning in November 2004, Max and Fifi began receiving substantial doses of Vitamins C and E and also Thymus Peptides. They have been under the care of a homeopathic vet while practicing elements of Bud’s FIV Therapy and have taken a multivitamin-mineral supplement (with some herbs and amino acids) prescribed by that vet, which includes Vitamin B12. In 2005 L-Carnitine and sesame oil (a source of beta sitosterol) were added, and later CoQ 10. In early 2006 they began taking Licorice root.

Outcomes. Neither Max nor Fifi has shown any evidence of FIV-characteristic problems and both are healthy cats. In 2005, Fifi did have an unexplained episode of kidney failure from which she has evidently fully recovered. The presumed cause is an unknown episode of traumatic injury. While early kidney disease can correlate with FIV infection, this does not seem to be the case with Fifi. Fifi’s CBC showed no abnormalities. Max has not had a CBC in recent years. Apart from minor ocular discharge in Fifi, both cats were doing well until contact was lost with the owner in 2008.

Discussion. Since FIV is highly variable in its expression, it is difficult to draw conclusions about the efficacy of medications or supplements when an asymptomatic cat remains asymptomatic.

3)

Cat. Sammie [m], born c. 2002 or before

Owner. Hedy Fraunhofer, U.S.

Disease Status. Asymptomatic

History. Sammie was taken in as a stray in February, 2005. At that time he was underweight and given a poor prognosis. He was also suffering from an upper respiratory and eye infection, possibly as a result of herpes virus infection, though there was no formal diagnosis. After being taken in, he became an indoor cat. Elisa and Western Blot confirmed an FIV infection, but concomitant PCR for FIV DNA was negative, indicating either the absence of detectable virus in PBMCs or a poor match between Sammie’s virus and the data base. It is unlikely that Sammie was born with FIV, although this was an initial fear.

Therapy: Sammie’s initial regimen consisted of Vitamins C, E, and B12 and Zinc. He also received daily L-Carnitine, NAC, Lactoferrin, Melatonin, Alpha Lipoic Acid, Thymus Peptide, and Moducare. Subsequently, L-Carnitine and NAC were stopped to avoid possible competition with Moducare. In October 2005 Sammie’s regimen became essentially the staggered regimen for asymptomatic cats described in Bud’s “Second Chance . . .” Green Tea and Grape Seed Extracts were added, alternating with Licorice/ Glycyrrhizinate. In March 2006 the staggered regimen was revised so that most supplements which had been given every other month were given two months out of three. In January 2009, FIV supplements were temporarily suspended in favor of supplements for health of the liver: SAM-e, milk thistle, and vitamin e, + 500 mg L-Carnitine because of its therapeutic value for hepatic lipidosis. In April 2009, Sammie began a slow start-up of his former FIV-regimen, although milk thistle has been continued for liver support. In July Prunella (100mg) and in mid-September 1 capsule of Oxstrin (optimized superoxide dismutase) were added to Sammie’s treatment regimen. Sammy's current very rigorous regimen of supplements is as follows. Two months out of 3: Vit E; Vit C 125 mg/twice a day; Thymus 50 mg/twice a day; Licorice 60-70mg; grape seed 25 mg (which means that every 3rd month, he gets both licorice and grape seed); lactoferrin 150mg; CoQ10 15 mg (third month: ALA 25 mg); Melatonin evening 1 mg (third month: B 12); Zinc 2-4 mg/twice daily prunella 100mg; even months: niacinamide 40-50 mg (first half week of the month: half); uneven months: green tea evening 100mg; every day: Moducare, Oxstrin. Remarkably, Sammie gets all but the last two added to his food.

Outcomes: Sammie was healthy and essentially problem free for several years after the start of his supplementation, although he did experience an episode of urinary tract blockage. His CBCs have been perfectly normal, although he has shown some high eosinophil counts that until recently did not seem to correlate with any visible health problems. Until late 2007, he also continued to register high Globulin counts. This was the reason for the intensification of the regimen in March 2006. Sammie’s supplements are strongly tilted in the direction of dampening overactive antibody synthesis. In his routine December 2007 bloodwork, for the first time Sammie registered normal globulin on his serum chemistry. In late July, 2008, Sammie had a sudden outbreak of gum inflammation, which quickly resolved with a short course of antibiotics. Bloodwork was unremarkable, except for a very high eosinophil count (much higher than previously), which often indicates either a parasitic infection or an allergic reaction. Sammie was given anti-parasitic treatment as a precaution. In early October 2008 Sammie suffered a brief urinary tract infection that resolved with antibiotic therapy. In December he showed signs of inappetence, in January 2009 was found to have elevated liver enzymes of unknown etiology, with hepatic lipidosis (fatty liver) felt to be the likeliest explanation. Other values (CBC/Chem) were unremarkable, except for continued (mildly) elevated eosinophils. By late January/early February 2009 all liver values (save a mildly elevated bilirubin) had returned to normal, although another urinary tract infection occurred coincident with the return of appetite and resolved after antibiotic therapy. Chemistries were normal by mid-March 2009, save for a marginal elevation of bilirubin. Mild gum inflammation in June 2009 improved without veterinary treatment.Apart from some minor pinkness around the eyes and hair loss on the ears (attributed to dust allergy) Sammy has been healthy and active since that time. A CBC/Chem in February, 2010 was normal, save for a mildly elevated Total Protein of unclear significance

Discussion. High Globulin counts alone are not considered a pathology and do not indicate disease progression. It may be worth noting that Sammie has received Moducare since around Aug 2005. High globulin as a result of hyperstimulation of the antibody response does not in itself suggest the ineffectiveness of Moducare, but Moducare does heavily promote its immune-balancing properties. Whether the normalizing of globulin levels it owes anything to Moducare or to the alteration in his regimen scheduling is difficult to say, but the impact of an intensified regimen is. A global explanation for Sammie’s health problems between mid-summer 2008 and midsummer 2009 is hard to see. His brief bout with oral inflammation may have been a systemic inflammatory reaction to a parasite; his liver problems may be related to his somewhat overweight status, this being a risk factor for hepatic lipidosis; his two urinary tract infections may or may not be related to his initial episode of FLUTD several years ago. Their lack of recurrence is a positive sign that they were unrelated to FIV status. It can be said with some confidence that Sammie's aggressive program of FIV therapy has certainly done him no harm; benefit is difficult to estimate, but he is presently an encouragingly healthy 8+ year old cat.

4)

Cat. Zouzou [m], born c. 1994 No further updates

Owner. Marcel Blanc, France

Disease Stage. Late ARC or early AIDS

History. Zouzou was taken in as a stray in January of 2005. In March 2005 he was treated for an epithelioma (a type of cancer) of the ear that was probably FIV-related. After suffering bouts of gingivitis, including the loss of two canines, Zouzou was diagnosed by Elisa as FIV+ in August, 2005. The finding was confirmed by PCR in October 2005. CBC showed lymphocytopenia ( low lymphocytes) and anemia. A prognosis of 6-12 months to live was given. Kidney values on serum chemistries showed marginal BUN and creatinine, suggesting possible initial stages of chronic renal failure.

Therapy. In late November 2005, Zouzou began receiving 60mg of Tenofovir (TDF), followed by 28.5mg of Emtricitabine (FTC) in mid-December. Lactoferrin was given as a supplement until March, 2006. At that time dosage of antiretrovirals was lowered to 50mg TDF, 20mg FTC. In May 2006 Vitamin C and E were begun as supplements. In April 2006 the Virbagen protocol of Feline Omega Interferon was begun (that is, a series of five injections on Day 1, Day 14, and Day 60) and was completed in June. Monthly maintenance injections began in July 2006. In October 2006, a new round of the 15-injection series was begun, which ended in December and Tenofovir was stopped at the same time. Emtricitabine was continued on an every other day basis in order to maintain a weakened strain of virus. In November 2006 NAC administration began at 150mg daily. It was stopped in mid-December 2006 out of concern sparked by new information on NAC and macrophage infectivity. (See Bud’s Second Chance . . .) In December Lactoferrin was begun again, but was stopped in mid-April because of problems of administration; Vitamin A to address recurrence of epithelioma replaced it. On 17 January 2007, Zouzou began a regimen of dilute natural interferon-a (Alferon), 25 IU. daily (seven days on, seven days off), distributed on oral tissue. NAC was restarted at about the same time. On May 31, 2007, Zouzou began 0.5 mg Methyprednisolone given orally each day in a gelatin capsule, along with 250 mg daily of Niacinamide and (somewhat later) 50mg of Selenium, these in addition to his established regimen of oral interferon (Alferon) and supplements (Vitamin A, Vitamin C, and NAC). On June 25, dosage of methylprednisolone was raised to .75 mg daily. In early August, unfavorable test results led to dropping Niacinamide, Selenium, and NAC from the treatment regimen and tapering off Vitamin C with a view to stopping it; Emtricitabine was discontinued. At the same time, Olive Leaf (300mg daily) was begun and Alpha Lipoic Acid shortly thereafter. In late September, Zouzou began taking the anticancer drug Gleevec, which has also shown in studies an ability to inhibit HIV replication in macrophages. Methylprednisolone was stopped in order to avoid interactions with the Gleevec. Gleevec was stopped because of rising liver-associated values. It could not be restarted because of a potential drug interaction with heart medication.

Outcomes. Zouzou died on 9 December 2007 of lung edema secondary to heart disease. His decline was sudden in onset. Following is a record of Zouzou’s blood values at various stages of therapy.

-------------Viral Load (RNA)-------Viral Load (DNA)--------W(hite)BC-----Lymphocytes------Hct----CD4:8

Baseline-------160,000/ml----------------140,000/ml-----------------6,000/mm3------900/mm3------------24.5

2 Months------42,000/ml------------------23,000/ml------------------5850/mm3-------1,170/mm3----------43.9

4 Months------20,000/ml------------------60,000/ml------------------6,150/mm3------1,476/mm3----------35.8

5 ½ Months--74,000/ml-------------------22,000/ml------------------6,000/mm3------1,500/mm3----------30.8

7 Months------Undetectable- ------------48,000/ml------------------9,130/mm3-------4,017/mm3----------31

9 ½ Months---200,000/ml----------------55,000/ml------------------11,200/mm3------6,160/mm3----------32

Post-Antiretroviral Drug Viral Loads and Hematology

12/2006--------45,000/ml-----------------34,000/ml-------------------8,860/mm3-------6,379/mm3---------44.5

04/2007--------50,000/ml-----------------70,000/ml------------------15,200/mm3-------6,384/mm3---------36.3

05/07----------------------------------------------------------------------9,910/mm3-------2,973/mm3----------31.6--.1

08/07-----------309,000/ml----------------20,300/ml------------------10,380/mm3------1,042/mm3---------40.7---.1

08/07-----------106,000/ml----------------18,100/ml------------------10,180/mm3-------814/mm3-----------27.6---.25

09/07----------------------------------------------------------------------7,900/mm3-------1,975/mm3----------19.3

12/07------------47,610/ml-----------------18,410/ml-----------------11,400/mm3-------2,300/mm3----------25.2

Viral loads, which initially fell off substantially after the beginning of antiretroviral drugs, more or less leveled off at four months and had begun to climb by 5 1/2 months on antiretrovirals. The September 06 viral load showed a higher level of free virus than any yet recorded, even at baseline, indicating that the RNA figure at 7 months was a testing error. The conclusion seems inecapable that the antiretroviral drugs lost their effectiveness as a result of viral mutation. This was a disappointing but perhaps not wholly unexpected finding. Prior to the 4-month test, dosages of both TDF and FTC were lowered because of increasingly abnormal kidney-associated values. Zouzou’s bloodwork at baseline had already shown abnormalities in kidney-associated values. Since TDF and FTC are both broken down in the kidneys, the combination (along with the antibiotic clindamycin, also broken down in the kidneys) may have proven too stressful to Zouzou’s kidney function. After the dosage adjustment , Creatinine returned to normal range, but BUN did not, though it did level off and never subsequently was a cause for concern. The first viral load following the end of combination antiretroviral therapy showed a substantial drop in RNA viral load, possibly attributable to antioxidant therapy with NAC and Vitamin C. The possible effect of the second round of feline omega interferon is difficult to assess, but could have been significant. A subsequent viral load, the first after beginning oral interferon, showed a doubling of proviral (DNA) load, and an assay after that showed a large jump in free virus (RNA) with a curiously low count of provirus (DNA). The steep decline in viremia measured by the final viral load test probably owed much to cancer therapy, but fell so much that olive leaf and ALA almost certainly had a role, as well. Hematology registered steady improvement after the beginning of antiretroviral therapy. Both white counts and lymphocytes took a substantial jump at the 7-month mark and held steady after the cessation of that therapy, until cancer later intervened. After the end of NRTI therapy, the lymphocyte-neutrophil differential varied considerably. A series of CBCs showed a tendency to inversion of the normal neutrophil dominance, but there was twice a correction. It is unclear to what extent–if any–these variations were owing either to therapeutic agents (feline interferon in the first case, Alferon thereafter) or clinical factors, such as gingivitis or primary immune activity directed at FIV. Red blood cells (as indicated by hematocrit) had been within the normal range since the beginning of antiretroviral therapy. The decline in hematocrit beginning in August 2007 was almost certainly owing to cancer. However, after starting Gleevec, hematocrit climbed to 31.9 (10/31), indicating a favorable impact of the drug and/or the amputation on anemia. After Gleevec was stopped, hematocrit fell to 25.2. Immune testing done in May and August 2007 showed a very low CD4:CD8 ratio of .1 The testing was done with an immunochemistry method to assess a CD4/CD8 ratio through counting CD4 antibody reacting patches and counting CD8 antibody reacting patches. The CD4/CD8 ratio so obtained mirrors only crudely the real CD4/CD8 ratio obtained through counting the individual CD4 or CD8 lymphocytes by flow cytometry. A third immune test done in early September 2007 showed a rise in ratio to .25. In the absence of absolute figures, the full significance of these surprisingly low ratios is unclear. Clinically, resolution of gingivitis began within weeks of starting antiretrovirals. After several relapses requiring additional administration of antibiotics, the problem disappeared entirely in early May, 2006, possibly owing to completion of the feline omega interferon protocol. Lactoferrin was judged ineffective for dealing with the problem, the reason for the first instance of its discontinuation. The owner reported a vitality following the beginning of antiretroviral therapy that was missing prior to that time. A very small epithelioma of one ear did occur, and was treated successfully. In October 2006 there was a minor recurrence of gingivitis. Shortly before the time that oral interferon therapy was begun, Zouzou began to show signs of a return of gingivitis. In January 2007 a veterinary visit revealed two areas of inflammation. In the months that followed, despite oral interferon therapy and repeat courses of clindamycin and metacam, mild to moderate gingivitis remained a problem. Apparent improvement of gingivitis with the addition of low-dose methylprednisolone was noted almost immediately, but by mid-June signs of increasing discomfort were reappearing, only to decrease and disappear entirely by the end of June, probably in response to an increase in dosage. No further symptoms of gingivitis appeared for the rest of Zouzou’s life. Apart from the spike in kidney-associated values, the owner observed no side effects of the antiretroviral drugs, nor any from the omega interferon, the oral natural interferon, or the low-dose methlprednisolone. In August 2007, following noticeable swelling, a diagnosis of osteosarcoma in one hind leg was confirmed. Amputation of the leg took place on 11 September 2007. Histological analysis of associated lymph nodes showed metastasis of a particularly virulent form of osteosarcoma. The owner elected not to have chemotherapy done, but began use of the anticancer drug Gleevec. In November 2007, echocardiography led to a diagnosis of hypertrophic cardiomyopathy, the left ventricular wall being found to be very thickened, the left ventricular cavity almost nonexistent, and the left atrium maximally dilated. In mid-November, an episode of lung edema (no doubt associated with cardiac disease) occurred and was resolved with diuretics. Zouzou died on 9 December 2007 of lung edema secondary to heart disease. His decline was sudden in onset.

Discussion. Zouzou’s total program of therapy had peaks and valleys, but can be characterized as generally successful. A cat who was lymphopenic, anemic, depressed, and significantly afflicted with gingivitis was rendered one with normal bloodwork, normal behavior, and relapsing mild to moderate gingivitis that eventually cleared entirely. A cat given months to live instead lived several years. The performance of NRTIs was somewhat disappointing from the standpoint of impact on viral load and staying power; more might have been hoped for. But NRTIs produced improvement in hematology, behavior, and inflammation before feline omega interferon therapy was begun and reversed a downward trend in disease progression. It is impossible to draw any conclusions about the wisdom of continuing emtricitabine at longer intervals in order to maintain a weakened strain of virus. With the feline interferon, further improvements in white cell profile and clinical resolution of gingivitis occurred. The addition of antioxidants to the regimen appears to have been responsible for the moderation of viral loads in the period after the failure of the NRTI regimen and so must be seen as successful, at least for a time. Beneficial effects of the oral natural interferon-a were undemonstrated and must have been subtle over time if they occurred at all. Low-dose methylprednisolone was effective with regard to gingivitis. It seems likely that cancer had a major role in the viremia and declining immune status which occurred subsequent to low-dose steroid therapy, but there are no grounds for concluding that the therapy was as successful in controlling primary FIV infection as it was the oral inflammation secondary to it. The final two viral load assays appear to validate the ability of olive leaf (in conjunction with the antioxidant alpha lipoic acid) to significantly impact viral burden. Because the only T cell testing took place in the months prior to diagnosis of cancer, it is difficult to know whether the overall control of Zouzou’s viral burden was reflected in improvements in the immune cells most immediately impacted by FIV. It is also difficult to say whether the development of cancer and heart disease owed anything to FIV infection–with which increased risk of organ failure and many forms of cancer is associated–or to any therapeutic agents.

5)

Cat. RPM [f], born c. 2002. No further updates

Owner. Allison Berneck, U.S.

Disease Status. Vertical (maternal) infection, ARC

History. The owner had had RPM and other members of the litter to which she belonged in her household since kittenhood. Beginning at an early age, RPM, began suffering repeated bouts of illness. The most frequent problem was recurrent upper respiratory and eye infections. There was also a bladder infection and episodes of depression attributable to infections the nature of which could not be identified with certainty. It is unusual for FIV acquired through life experience to produce so many problems so soon. This, plus the fact that RPM had been an indoor cat since kittenhood, suggested that she had gotten the infection from her mother at or shortly after birth. Elisa confirmed that RPM was FIV+. CBCs showed no abnormality suggesting immune suppression.

Therapy. In mid-February 2006 RPM began receiving several supplements, notably Prunella, Thymus Peptide, and Vitamin C. On 19 March 2006, she began the five-herb combination with which Bud first achieved undetectable viral load: Boxwood (SPV30), Olive Leaf Extract, Curcumin, Licorice/ Glycyrrhizinate, and Prunella. Her regimen also included Thymus Peptide, Acetyl L-Carnitine, and Vitamin C. Supplements were suspended in a liquid and syringed down the throat. A brief bout of diarrhea was originally thought to have been caused by Curcumin, but subsequent experience suggested that this was not the case. In mid-May NAC and Alpha Lipoic Acid replaced prunella as part of a routine rotation of supplements. Boxwood and curcumin were to be rotated out for three and two months respectively around 19 June 2006. However, around this time therapy was abruptly suspended.

Outcomes. No side effects attributable to a very extensive therapeutic load were noticed during the 4+ months of therapy. The owner characterized RPMs quality of life during this period as good and superior to that which had been the case prior to beginning therapy. In mid-June RPM began showing inactivity, though without loss of appetite. After a week or so a trip to the vet resulted in the diagnosis of a cancerous tumor of the mammary gland, about 3cm in size. No information can be reported about the type of tumor. The owner elected not to treat the cancer and to suspend the FIV therapy. A minor bladder infection was diagnosed at the same time as the tumor. The vet speculated that inactivity may have been responsible. After this point, contact with the owner was lost.

Discussion. It is difficult to draw conclusions about the effectiveness of the supplement regimen on the basis of RPM’s experience. The most that can be said is that a determined owner demonstrated the possibility of a high degree of supplementation of strong-tasting herbs and other supplements in a reluctant cat.

6)

Cat. Spotter [m], born 1990. No further updates

Owner. Katherine Rylien, U.S.

Disease Status. ARC, possible AIDS.

History. Spotter was raised from kittenhood in his current household. The owner has no idea when he acquired FIV infection, but he was an indoor/outdoor cat for many years. The first symptom of his infection was progressive weight loss resulting from inappetence, first noticed in August 2005. A vet diagnosed dental problems in December 2005, and recommended a tooth extraction. This did nothing to alleviate Spotter's weight loss, which eventually amounted to nearly half of his original sixteen and a half pounds. Spotter also demonstrated some neurological disturbance, including two violent seizures observed by the owner, who suspects there may have been other such events that were not observed. He also suffered from diarrhea and vomiting. FIV was diagnosed in February of 2006. Oxazepam, later replaced by cyproheptadine, produced a return of appetite.

Therapy. From late June to early August 2006, Spotter received an iodine-containing liquid orally with a syringe, 1.5cc twice daily. The liquid, called DAG Solution (sold as a gargle), contains phenolated Iodine in a base of Irish moss. Although Iodine is known to have a number of antibacterial and antiviral actions, the mode of action against FIV is uncertain. One researcher has speculated on enhancement in the reticulo-endothelial system, in part a macrophage network. Other research has found it to inhibit (HIV) viral cell entry.

Outcomes. Spotter tolerated the oral infusions well. During the first few weeks, his diarrhea disappeared completely and did not returned. The owner also reported less vomiting and better "natural" appetite. Spotter continued to require small doses of an appetite stimulant (cyproheptadine) approximately every other day. One of the seizures observed by the owner took place after 3 weeks of the DAG treatment, so the neurological symptoms did not appear to be alleviated. Around the six-week mark of therapy, inappetence and vomiting recurred. The owner stopped therapy at that point. Spotter was euthanized in mid-August 2006.

Discussion. There is no reason not to take the owner’s word that there was improvement and that, therefore, iodine has some potential for beneficial action on some part of the disease process.

7)

Cat. Carlo [m], born c. 1995

Owner. Ulrike Roediger, Germany

Disease Status. ARC

History. Carlo was a stray, who has been part of his owner’s household since 1996. For about the first four years of this period he was an outdoor cat. During this period he suffered lung inflammation, which was successfully treated with antibiotics. In May, 2004 he began to show dermatologic disorders (dandruff, hair loss) at the base of the tail which did not resolve, despite testing and treatment. In June 2004 Carlo tested positive for FIV. Oral inflammation resolved after dentistry. By January 2005 he was also showing lymphadenopathy (swollen lymph nodes) from the submandibular area to the base of the spine and exhibited general fatigue and depression. In February 2005, continuing dermatitis finally resolved with Clindamycin (500mg daily), although skin biopsy produced no specific finding.

Therapy. Beginning in November 2004, Carlo received a series of 5 injections of Feline Omega Interferon with a view to improving his general condition. From April 2005 through September 2006, the owner, inspired by theories of Dr. Alfred Plechner, began giving monthly depo injections IM of 40% methylprednisolone solution at a dosage of 1 mg/lb. Initial injections were .375 ml, with reductions in dosage as improvement occurred. In October 2006, Carlo began receiving Olive Leaf Extract (OLE) and small doses of Niacinamide supplements. Both continue to be used to date with occasional treatment interruptions for various reasons. At the same time, oral Prednisolone at a dosage of .5 mg daily was substituted for monthly injections. In early 2007, Vitamin C and Vitamin B-Complex, were added to the list of supplements. Dosage of oral Prednisolone was increased to .75 mg daily for two weeks in February 2007 because of a recurrence of hair loss and dandruff, then lowered again to .5 mg. In 2008, Lactoferrin was begun, along with Cat-Revital, a commercial vitamin supplement for chronically ill cats. In early May 2008, Alfaferone natural interferon-a was begun, seven days on, seven off at 50 IU daily, applied to oral tissue. Lactoferrin and Vitamin C were stopped in the fall of 2008, and silymarin was begun for liver support. In November 2008, administration of Alfaferone ceased after 6-months of use out of concern for possible allergy to the human source of the drug. Silymarin was replaced by SAMe (Denosyl) in late January 2009. At present, Carlo is receiving Niacinamide, Silymarin, and low-dose prednisone. Metronidazole and fresh colostrum-milk procured from a local farm are also being used periodically, the former to address GI-related problems.

Outcomes. Clinical. Feline omega interferon had no effect on Carlo’s oral disease or on the general deterioration of his condition at the time. The owner is unsure, however, whether the product used had been properly stored or whether the dosage used was appropriate. Injectable prednisone produced a marked improvement in clinical health. (Apart from their anti-inflammatory action, glucocorticoids inhibit FIV-infectivity by retarding cell activation.) Lymphadenopathy began to recede in April 2006. Carlo gained weight excessively throughout 2006, partly as a result of improved food consumption, partly as a side effect of steroid use. Tapering of steroid dosage brought weight under control, and he slimmed down from 7.5 kg to 6.4kg, Carlo showed illness and loss of appetite in early June 2007, which clindamycin cleared up. The problem of hair loss and skin irritation, however, has proven recurrent to date, sometimes better, sometimes worse. Remissions in late winter and early fall of 2007 dwindled in November, with hair loss and marked skin sensitivity being displayed: twitching, overgrooming, etc. For a time in early 2008 and then again in late summer, Carlo was less active of than normal. Precautionary treatment with antibiotics seemed to produce improvement. In October 2008 Carlo was diagnosed as having food allergies. A limp that began in April 2008 gradually improved and appears to have been a mechanical injury. For several weeks, vomiting occurred the morning following admin of Alfaferone, necessitating its suspension. Resumption of admin went without incident. Similarly, in November Carlo experienced bouts of itching following several administrations of Alfaferone. Whether this was coincidental is unclear, but administration of the interferon ceased at that point. By December 2008, clinical health had declined significantly, with Carlo behaving lethargically, moving stiffly, and exhibiting intermittent disturbance in appetite and litter-box etiquette. By February 2009, these symptoms had improved, particularly appetite. SAMe appeared to be at least partly responsible for the improvement. Between February and July 2009, Carlo was active and healthy, although he had a brief, unexplained depressive episode in March. However, throughout July, he suffered from recurrent nausea, stiffness, inappetence, and dehydration. Pancreatic testing (and subsequently toxoplasmosis testing) was negative. Symptoms waxed and waned through August and September coincident with treatment with antibiotics and an immunoglobulin-supplying supplement (Serimmun). From late September 2009 on, Carlo began moving and feeling well, although appetite was variable, largely because of dental problems. In February 2010 several teeth were removed, and appetite improved. In March and April stiffness, poor appetite, and depression were a particular problem, seemingly associated with chronic herpes infection, since Valtrex (an antiviral) proved helpful. Since then Carlo has had good and bad days, the bad days being defined by loss of appetite, vomiting, lower GI difficulties, and overgrooming. Metronidazole has been helpful in the first three regards.Hematological. A record of Carlo’s relevant hematology follows:

Date-----------------11-23-04---03-30-05---08-12-06---02-14-07---05-20-08---12-19-08---7-23-09---2-4-10

Hematocrit--------------45-----------44-----------48----------36----------46------------45--------42----------42

White Cells-----------6,600--------7,600-------5,100------6,200-------8300---------5900------5000-------5700

T-Cell %--------------------------------29---------29.5--------44.5-----------------------27

CD4+ %---------------------------------8-----------8.5---------14--------------------------9

CD4/CD8 Ratio------------------------.5-----------.4----------.75------------------------.56

CD4+ Count (M/l)--------------------268---------186--------373-------------------------271

CD8+ Count (M/l)--------------------535---------461--------506.5----------------------481.5

B-Cell Count (M/l)-------------------1705--------976-------1066.4---------------------1489.5

As the sequence of reports indicates, despite a general lack of change in red and white cell values, Carlo’s CD4+ counts declined during the period of his use of injectable steroids, a trend which was inversely proportionate to his clinical improvement. This trend held through the early period of his switch to oral steroids; however, by early 2007 a dramatic improvement in immune status, as measured by T and B cell figures, was evident. Although B cells continued to outnumber T cells, which is not a normal relation, the proportion grew much closer, indicating a healthier cell-mediated immunity and a less hyperactive antibody response of the sort characterizing FIV infection. T cells generally increased, and the CD4/CD8 ratio got closer to that of an FIV- cat. CD4+ counts, while not those of an FIV- cat, grew closer to normality. May 2008 bloodwork showed a healthy WBC and HCT with a slight elevation of T4 of uncertain significance. A November 2008 check of renal values was normal, showing no harm to kidneys as a result of long-term steroid use. However, December 2008 immune testing showed a distinct decline, with a return to values resembling those of the pre-lowdose steroid period. This and a reversed neutrophil:lymphocyte ratio reflected a clinical situation of general unhealthiness. July 2009 and February 2010 bloodwork showed a continued low WBC, although n:l ratio normalized and mild neutropenia was evident. An elevation of monocytes and BUN in the first of the two was not evident in the second.

Discussion. Results to date suggest a beneficial clinical impact of glucocorticoids generally and a beneficial impact on immune status of the switch from long-acting higher-dose injectable to short-acting low-dose oral prednisone. It is not surprising to see the higher dosage impact clinical presentation while being far less impressive in the lab reports. The upward trend in laboratory values after the switch to low-dose steroid offers a tentative validation of low-dose steroid therapy. The benefit of supplements, individually and collectively, is difficult to evaluate because of the number and changing combinations of therapeutic agents Carlo has received to date. Whether Alfaferone and low-dose prednisolone were an effective combination is also hard to say, since prednisolone alone produced improvement beyond which Carlo did not clearly advanced. White-cell hematology since 2009 may point to some decline in the effectiveness of low-dose steroid therapy + supplements, but serum chemistries and the most recent developments in clinical health are remarkably encouraging. Response to therapy points to some low-level chronic herpes, allergy, and small-bowel inflammation, all probably somewhat related to FIV status.

8)

Cat. Cindi [f], born c. 2000 No further Updates

Owner. Marya Gutek, U.S.

Disease Status. FIV+/Actively FeLV+

History. Cindi was rescued at the approximate age of 3 and adopted by the owner shortly thereafter. At the time of rescue she was malnourished and infested with fleas, mites, and roundworms. She tested positive for both FIV and FeLV From the time of adoption she has suffered from severe gingivitis, which was controlled until 2007 by doxycycline 20 mg bid. She has also suffered recurrent eye inflammations that are likely due to herpesvirus, which responds to lysine and sometimes topical antibiotics. During the first year after rescue she began to lose weight and show inactivity. Bloodwork showed significant FeLV-related anemia which up to the present has been controlled with prednisolone 5mg (min) sid. Her treatment regimen has also included oral interferon (continuous dosing), Ester C, and Pet Tinic. In the latter part of 2006 Cindi began to deteriorate, in part due to the owner’s poor health and consequent inability to medicate consistently. In April 2007 she showed weight loss and drooling; sores were found under and on the tongue. Clavamox was tried and abandoned because of diarrhea; metronidazole failed to help. By June 2007 Cindi had gained some weight. She remained mildly anemic, but otherwise showed normal bloodwork

Therapy. On July 1, 2007, Cindi began receiving 35 mg of Tenofovir (TDF) once daily and 10 mg of Lamivudine (3TC) twice daily, both in liquid form, though the tenofovir has proven very bitter. On 13 July dosage of tenofovir was cut back to 26mg daily out of a concern for rising kidney values. Niacinamide (70 mg bid) and CoQ 10 (25 mg) were added to the treatment regimen. On 9 August Cindi began a five-injection series of Feline Omega Interferon, which has proceeded to date according to the normal Virbac protocol of series on Day 0, Day 14, and Day 60. On 20 August dosage of tenofovir was raised to 30mg daily and dosage of lamivudine was lowered to 5 mg bid. Dosage of tenofovir was subsequently lowered to 25mg owing to renewed rise in BUN and creatinine. Owing to aversion to being medicated, there is some doubt whether Cindi had been getting all of her medications and supplements. Also part of Cindi’s regimen were 100mg of MSM, 250mg lysine, 150mg NAC, 5 mg prednisolone, 12 mg doxycycline bid, slippery elm, multivitamins, B-complex and B12 sublingual, and Buprenex for pain

Outcomes. Side Effects. Within twelve days of starting TDF and 3TC, Cindi was registering abnormal BUN (48, 51) and creatinine (1.4, 1.6). Following dosage adjustment, values dropped (31 and 1.3 respectively by day 39). When dosage of TDF was raised to 30mg and 3TC lowered to 5mg/bid, BUN rose again (45), as did creatinine (1.8). Part way into the first and second series of interferon injections, Cindi became lethargic and reluctant to eat. Despite reservations, the third series was completed as scheduled. Lowering of tenofovir dosage to 25 mg again brought creatinine and BUN to normal or near-normal range. Hematology. Red cell values remained more or less constant after beginning TDF and 3TC (PCV 20, 22, 20, and 19.1.) Until October 2007, when it dropped to 14. By November 2007 memrane color was more pinkish, but no new bloodwork was done. The white cell count has remained within normal range, but the lymphocyte count, which had been 1001 on day 12 and 1245 on day 26, plummeted to 240 on day 39. The significance is unclear. The report cited “+1 toxic neutrophils,” possibly indicating a bacterial infection, although there was no clinical evidence of one. Cindi had been and remained on antibiotic therapy during this period. The latest report (September 2007) showed lymphocytes up to 720 (still quite low) but white count generally down to 3,000 (low). Veterinary opinion was that bands and reticulocytes (immature cells) indicated that Cindi had been fighting an infection of some sort. Clinical. The owner reported the following: “Her mouth is a lot better since I started giving her niacinamide and CO-Q10. Her gums look great, there is only one very small sore left on her tongue, and almost no drooling. She's been more active. Her eyes (chronic herpes) showed a dramatic improvement after about the 3rd FOI injection. On the down side, she lost 1/4 lb between her appointment on 7-26 and the one on 8-9 and her appetite isn't quite up to par.” Subsequently, all trace of tongue lesions disappeared and her coat looked better than it had in some time. She resumed grooming and began eating better than she had while actively receiving interferon. However, a concurrent discovery of demodex mites indicated a probably significant level of compromised immunity. By November 2007, Cindi’s mite infection had cleared up (though the dip proved extremely stressful), but her weight had fallen to 4.8 lbs and a veterinary physical exam revealed a thickening of intestine possibly consistent with lymphoma. She died in early November 2007.

Discussion. No other cats so far given tenofovir have shown Cindi’s kidney sensitivity at such a dosage. However, the fact that dosages around 25 mg twice normalized kidney values indicates, when viewed in concert with Zouzou’s experience, that there seem to be limits to acceptable dosage of tenofovir in cats that were never reported in high-dose studies. Whether the improvement in oral disease prior to initiating interferon therapy was owing to the antiretroviral drugs, the supplements (both of which have some track record in improving oral disease), or both is difficult to say. The interferon can be said to have performed as expected (very effectively) with regard to the chronic herpes. Whether the immunosuppressive dosage of prednisolone permitted complete or substantial antiviral efficacy of the interferon can never be known. The probability that Cindi had intestinal lymphoma clouds the significance of her up-and-down clinical responses to therapy and the plunge and mild rebound in lymphocytes. Lymphoma frequently has minimal noticeable impact on bloodwork until advanced stages, but Cindi’s does seem to have been well advanced. Whether the absence of the presumed lymphoma would have altered the performance of her highly aggressive therapeutic program is impossible to say, but Cindi’s experience doesn’t validate it.

9)

Cat. BJ, born early 2007 No Further Reports

Owner. Carole Kimball, U.S.

Disease Status. FIV+/actively FeLV+, possible vertical (maternal) infection,

History. BJ was raised by his owners from birth, living outside in a barn. He was FIV/FeLV tested at 2 months and 3 months and tested negative both times. However, between the 3rd and 4th month (early spring 2007), he started sneezing and this time tested positive for both viruses. His mother tested negative for both. It has therefore been assumed that he was infected by a stray tom, although there is precedent for a mother having cleared FeLV infection subsequent to passing on the virus but prior to being tested. This would not, however, explain her FIV- status. He was placed on oral interferon-a and vitamins. In late May, the owner felt several small pea-sized lumps behind his front leg. A vet also found enlarged lymph nodes in the jaw area and a needle aspirate found lymphoma. Chemotherapy with adriamycin and cytoxin was administered. Subsequently, a repeat needle aspirate showed no lymphoma. Lymph nodes, while smaller, never went completely back to normal. It is unclear whether the cancer went into remission or whether the initial diagnosis was wrong. BJ seemed in normal health until early August 2007, when he began running high fever (106). Bloodwork was normal (and has remained so). During an extended veterinary stay, antibiotics (amikacin) and NSAIDS (ketofen) were administered, along with subcutaneous fluids. An injection of interferon-a brought temperature down to normal, but fever soon returned. From that time forward, BJ's temperature became somewhat controllable with injections of short-acting dexamethosone. He maintained a normal temperature for two days, then it would begin to creep up again. An injection would bring it down within a day and then the cycle would repeat. Despite these fluctuations, BJ continued to feel good, eating and eliminating normally.

Therapy. On 10 September 2007, BJ began receiving Feline Omega Interferon, according to the standard Virbac protocol: 1 MU/kg in series of 5 daily injections begun on days 0, 14, and 60. No other agent was given concurrently. In late September Vitamin B12 and C injections began. In early October, tentative diagnosis of hemobartonella and enlarged heart prompted admin of doxycycline and Benaz-A-Heart, respectively. Chemotherapy with Adriamycin was reinitiated. Because of recurrence of fever and elevated white count, the final interferon series was begun around day 50. An injection of Elspar, another chemotherapeutic agent, was given between the second and third series. The final interferon series was given on day 50 instead of day 60 because of concerns about three consecutive days of 105 temperature. A second injection of Elspar was given concurrently with the third injection of the final interferon series, and ten days (13 Nov) later a third was given. Doxycycline was stopped in the interim because of diarrhea, which was treated with metronidazole. Maintenance therapy with weekly interferon injections began on 16 November. In mid January 2008 Lymphocyte T-Cell Immunomodulator (LTCI, formerly Thymic Protein A) was begun (coincident with another Elspar injection) with the intention of replacing the interferon. However, the owner chose to continue the interferon, as well, with weekly injections of the former on Tuesday and the latter on Friday. Throughout 2008 the period between Elspar between his Elspar treatments was lengthened from the original 10-day cycle to three months. No Elspar was administered between October 2008 and June 2009. After June bloodwork, Elspar was resumed.

Outcomes. BJ’s temperature dropped to 101 following the first injection of Feline Omega Interferon and stayed there through the entire first series. On the fourth day after the final injection of the first series, his temperature began to rise, and was up to 104.5 by the next day. Subsequently, a pattern of temperature drop with weight loss during interferon therapy and temperature rise with weight gain between therapeutic series prevailed. Apart from the weight drops, the only side effect was loose stools for one day following the first injection. Despite the fact that BJ continued to look, eat, and feel well apart from extreme thinness (5.3 lbs), his hematocrit dropped steadily. In early October 2007 it reached 15. No hemobartonella was visible on slides following antibiotic therapy. In late October, following an injection of Elspar, hematocrit rose to 25. Temperature fell into normal range on the first day of the final interferon series, but hematocrit declined to 22.5. Hematocrit began rising following the second Elspar injection, but after a brief period of normality, temperature rose once again to 105; then hematocrit fell to 20 before rising again to 28.7 following the final injection of an Elspar series and fluctuated between 27.7 and 32.7 for some time afterward. Temperature was normal following the final injection of Elspar and remained normal during the interferon maintenance regimen until the end of December 2007, when a fever refractory to interferon administration returned. In early January 2008 a coccidia infection appeared and was resolved. The Lymphocyte T- Cell Immunomodulator begun in mid January controlled temperature for several weeks, but a fever spike several weeks into the regimen resolved only with an injection of interferon. In late January BJ received another Elspar injection to which he responded favorably. There was no fever after late February 2008. From March to October 2008, hematocrit cycled between the mid-20s and 30, going up about 10 days after an Elspar injection, then holding steady for a time before dropping again. As of October 2008, BJ’s weight stood at 11.4 lbs, up from a low point of 6 lbs. He was playful and active, with a very healthy appetite, although a late-fall urinary tract infection occurred and resolved. In early February 2009, the bladder infection recurred and again resolved with antibiotics. Hematocrit varied between 28 and 34 from late 2008 to Summer of 2009. Bloodwork from early December 2008 showed an unusually low white cell count of 4000. However, a subsequent CBC showed an increase in the WBC to 4,900 with a subsequent bounceback to 6,400. By June, however, WBC had declined to 1300, then began a steady climb to 12,400 with high lymphocytes and numerous malignant cells observed. In July 2009, decline was precipitous. After mid-July, fever returned, hematocrit declined to 21.7, and WBC rose to a leukemic 50,000, with high lymphocytes. Lung x-rays revealed fluid. BJ was euthanized at the end of July 2009.

Discussion. Double-positive status adds a complicating element to the issue of FIV status. BJ does not seem to have been born with his FIV infection, his bloodwork at the onset of his decline prior to therapy suggested that he was not showing effects of the initial acute FIV infection, and it was early to begin seeing characteristic effects of the post-asymptomatic phase of FIV infection. It must, therefore, be assumed that FeLV was BJ’s primary problem, although many studies confirm that FIV+/FeLV+ double-positive cats have worse clinical and hematological parameters than cats with FeLV only. The early pattern of decline in hematocrit along with fever following interferon injections, with relapse of fever shortly after the end of each series, at that time suggested that the interferon was not significantly impacting the overall disease process and was unable to check it without concurrent chemotherapy. A five-week hiatus of fever in November and December of 2007 while on interferon maintenance therapy suggested modest impact on the disease process; the relapse of fever suggested that the impact was neither major nor decisive. Studies of FOI in cats with FeLV have identified preexisting anemia as a major factor in suboptimal response. Although Lymphocyte T-Cell Immunomodulator did not initially show clear evidence of the hematopoietic action claimed for it, the concurrent use of LTCI and FOI eventually helped to maintain an acceptable status quo and proved more successful than the use of FOI alone. Hematological parameters slowly improved. The level of weight gain that occurred, the eventual cessation of Elspar therapy, and more than a year without fever represented significant improvement and suggest synergy between the two immunomodulators. Although BJ continued to suffer periodic secondary infections, considering how dire his situation was at the outset of therapy, his immunomodulating therapy must be considered a notable success. His eventual decline was inevitable, but two years of quality life with therapy is a signficant achievement.

10)

Cat. Cole [m], born c. 2005

Owner. James Murphy, U.S.

Disease Status. Possible vertical (maternal) infection, Asymptomatic

History. Cole was adopted by the owner from a shelter in June 2006. In June 2007, routine bloodwork, normal in all other regards, showed marginally high albumin and low platelets (regarded as a testing artifact). In March 2008, routine bloodwork had shown the same marginally high albumin and the same low platelets (again regarded as an artifact). This time, however, despite a WBC roughly similar to that of the previous bloodwork, neutrophils stood at a low 1760, with a reversal relative to lymphocytes of 20%:75%. Despite normal red cell indices, a “+1 hemolysis” was noted. All physical finding were normal. Weight gain (9 oz.) had occurred since the previous visit. A somewhat depressed appetite was the only abnormality noted. An injection of antibiotic subsequently improved appetite.

Therapy . At the beginning of April 2008 Cole began receiving 125 mg Lactoferrin daily, which was raised to twice daily in September 2008.

Outcomes. In September 2008 Cole became somewhat anorectic, though otherwise his behavior was normal. A veterinary exam was unremarkable, although bloodwork showed a continuation of the pattern of reversal in lymphocytes and neutrophils (6138/2697) and the same notation of “hemolysis +1.” Otherwise, hematology and serum chemistries were normal. Antibiotics did not resolve the poor appetite. Cyproheptadine normalized appetite. By November 2008 use of cypro became infrequent, and “cat grass” provided for consumption was largely successful in normalizing appetite. Since November 2008, appetite has been variable, although Cole otherwise felt and acted normally. In June 2010, Cole began to act lethargic and sleeping excessively. Appetite declined further. A veterinary exam revealed nothing problematical. Bloodwork was unremarkable except for a low neutrophil count of 1386 and a n:l ratio of 18:82%, both the lowest yet recorded. After about two weeks, all symptoms except for poor appetite resolved.

Discussion. It seemed possible (though not proven) that lactoferrin played a role for a time in the normalizing of serum albumin values, the raising of neutrophil numbers, and the slight improvement in N:L ratio (29%:66%). Although symptoms of the recent episode of depression spontaneously resolved, the very low neutrophil count (though untroubling to the vet) is somewhat disturbing. The significance of the reversed ratio is unclear at this time, though it has sometimes been noted in FIV+ cats as a result of chronic viral activity. The owner feels unequal to a more aggressive treatment, and since Cole's lactoferrin is added to food that often goes uneaten, it is difficult to conclude that it has not been helpful.

11)

Cat. Rojo [m] born c. 2002 No Further Reports

Owner. Michelle Spayde, U.S.

Disease Status. AIDS

History. Rojo’s owner, who does rescue and TNR, adopted him in 2005, following the adoption of his litter mate. Both, the owner reports, were former lab cat who lived for a time with a large population kept by a “hoarder.” Rojo barely survived an upper respiratory infection present at the time of adoption, and has suffered repeated infections since that time. Rojo has been ill “off and on” since October or November of 2007, behaving in a depressed and inactive way following a prior history of outgoing and active behavior. He also became anorexic, requiring intermittent syringe feeding. Bloodwork done at the beginning of March 2008 (see Outcomes), which showed both lymphopenia and neutropenia, convinced the owner to try the Imulan Lymphocyte T-Cell Immunomodulator(LTCI). Oral interferon was administered at standard dosage during the period between this bloodwork and the beginning of LTCI therapy.

Therapy. On 4 April 2008, Rojo began receiving weekly subcutaneous injections of LTCIM at standard dosage. After completing a series of four injections on 24 April 2008, he received another injection two weeks later, and yet another (23 May 2008) after a two-week interval. At that point he began a maintenance regimen of injections every four to six weeks. Since beginning LTCI, antibiotic therapy has been instituted several times in response to a positive hemobartonella/M haemofelis test and as prophylaxis against recurrence of URTI.

Outcomes. A record of data from Rojo’s complete blood counts (CBCs) follows:

DATE........................3/1/08................ 4/4/08.............4/17/08.............5/1/08............5/23/08..........7/24/08

Hematocrit.................37.2...................53.1.................39.3..................47.3................65.4

WBC..........................2.0......................2.4..................1.8....................3.6..................4.3.................2.3

Neutrophils................860....................1200................774..................1836...............2881

Lymphocytes.............640.....................792..................666..................1080...............731

Hematology. The owner was warned to expect a temporary decline in white cell counts and differentials following initiation of therapy with LTCI. Records show that this decline did take place, followed by a substantial rebound and increase in both WBC and neutrophils on bloodworks subsequent to 4/17/08. Lymphocytes, however, declined on 5/23/08 after a brief increase on 5/1/08. The reason for and significance of that decline remain to be seen, but a reaction of the specific immune response to Mycoplasma infection is a possibility. The pattern of increase in hematocrit to abnormal levels followed by decline to normal levels is puzzling and unexplained at this time. Serum chemistry done on 4 April 2008 showed abnormally high globulin, total protein, and amylase and abnormally low AST (SGOY), a liver enzyme. A preliminary report on July blood work showed a drop in WBC to 2300. A relation of recent bloodwork results to the Mycoplasma infection is a possibility. Clinical. Shortly after beginning the LTCI regimen, the owner noticed a difference in activity and demeanor. She described Rojo as “spunky” and “playful,” adding, “He is a completely different cat.” Also observed, however, was a pattern of appetite loss for several days following each injection, after which appetite would rebound somewhat. A weight loss of approximately .8 lb occurred during the period between the 4/17 and 5/23 bloodwork At the time of the 5/23 veterinary visit, Rojo was running a temperature of 104.9 with clouding of one eye. Testing done at that time subsequently returned a strong positive for hemobartonella/Mycoplasma haemofelis. By late July 2008, lost weight had been regained, and Rojo displayed normal appetite and behavior, a pattern which continued until contact with the owner was lost in August 2008.

Discussion. Unless unexplained aspects of his recent history eventually suggest otherwise, Rojo should be regarded as an AIDS-stage cat at the time therapy was begun. In this light, his rejuvenation following the beginning of therapy speaks well for the effectiveness of LCTI. By the same token, the unexpected increase in neutrophils and the more predictable increase in WBC generally bear out information emerging from trials of the product that suggested a beneficial effect on cell types other than lymphocytes. The late July plunge in WBC is of uncertain significance. The surprise has been the absence of sustained influence on lymphocyte counts by a drug that purports to be T-cell lymphoproliferative. Although only flow cytometry could have shown how many lymphocytes before and after therapy were T-cells, studies have claimed an increase in lymphocytes generally that has failed to materialize to date. It is also unclear whether the secondary polycythemia suggested by red cell data has anything whatever to do LTCIM and whether the onset of illness some 6+ weeks into therapy showed a lack of immune reconstitution at that time. Hemobartonellosis has been shown in some studies to be a chronic infection with a possibility of recrudescence, so the possibility that Rojo’s infection is of long standing and re-emerged as a result of poor immunity cannot be discounted. The pattern of anorexia immediately following injections strongly suggest that, at the very least, short-term anorexia is a side effect of the drug.

12)

Cat. Tigerlily (f), born c. 2000

Owner. Phoenix __, U.S.

Disease Status. Possibly ARC

History. Tigerlily was adopted by the owner in 2003 after having been fed as a stray for a period of time by neighbors. She was diagnosed with FIV shortly before adoption after a landlady trapped her and took her for spaying to an SPCA clinic. With no one prepared to adopt Tigerlily, the owner kept her for a time in a garage attached to her apartment. Eventually, she became part of the owner’s multicat household. Some moderately extensive dental work has followed. Tigerlily has had chronic ear wax accumulation since the time of adoption, which has been controlled by cleaning her ears. In recent years she has developed arthritic knees, & erosion of a disk in her mid-back. She is also subject to skin disorders; a number of allergic reactions have caused rashes, inflammation, and hair loss. Connection of any or all of these problems to FIV+ status is uncertain, but quite possible. Routine bloodwork done in late summer 2007 showed moderate leukopenia with moderate lymphopenia and neutropenia and a mild elevation of the albumin/globulin ratio. (See Outcomes.) Lab results had been normal prior to this bloodwork. Prior to current therapy, Tigerlily received Vitamin C, lysine, glucosamine and baby aspirin for arthritis, EFA’s ( and periodic antihistamines) for skin conditions, and other nutritional supplements.

Therapy. Beginning at the start of 2008, Tigerlily began receiving supplementation (250 mg daily) with Bovine Lactoferrin, in addition to her regular supplements. In mid-winter 2008 there was a treatment interruption of uncertain duration, although treatment later resumed.

Outcomes. Following are selected blood parameters previous to and following initiation of therapy.

Date..........White Cell Count ......Absolute Neutrophils .......Absolute Lymphocytes......N/L Percentages

9/07...................3.1........................................1457...........................................1426...................................47/46

7/08...................4.3........................................2709...........................................1462...................................63/34

8/09...................4.5........................................1890...........................................2025...................................42/45

Both WBC generally and absolute neutrophils particularly showed substantial improvement at about seven months post-therapy. In addition, the albumin/globulin ratio (A/G) went from a mildly high 1.0 to a high-normal .8. The most recent bloodwork showed a steady WBC but a mild neutropenia that was less pronounced than on the bloodwork preceding inititation of therapy. No significant change in clinical health has been evident. August 2009 bloodwork showed a high-normal creatinine and mildly elevated BUN, indicating possible early CRF. There has been no report on hematology or clinical condition since that time.

Discussion. At the point in Tigerlily’s disease process covered by this report, the clinical picture has been undramatic, but suggestive. Eight or nine years old is young for a cat to be showing the kind of joint and spine disease that she has exhibited, and it is possible that secondary immune dysfunction related to FIV has played a role in these regards, as well as in the liability to skin disorders and possible early CRF. Among bovine lactoferrin’s many potential benefits are (1) improvement of neutrophil activity and (2) a pro- T-Helper 1 immunomodulatory effect that might favorably impact chronic antibody production. In the first regard, various studies have shown that lactoferrin increases neutrophil precursors in the blood, and raises binding and phagocytic activity of neutrophils. Whether that would produce a gain in absolute neutrophil numbers over time is unclear. But going from a disturbingly low count of 1426 to a low-normal 2709 can only be considered a favorable outcome. The subsequent rebound to 1890 somewhat mutes the tendency to strongly credit lactoferrin for the previous gain. Low neutrophils predict liability to infection more than do low lymphocytes, although it may be that Tigerlily’s are chronically cyclic with regard to mild neutropenia. In the second regard, a borderline high A/G ratio in an otherwise healthy-seeming FIV+ might be the result of chronic hypergammagloblinemia as a result of chronic FIV antigenic stimulation. Lactoferrin does have a TH-1 immunomodulating effect that could be helpful in normalizing a borderline high A/G ratio. Most recent bloodwork showed a very normal 0.4 ratio. So while lactoferrin could be responsible for some favorable changes in blood work and for the general maintaining of clinical health, it is also possible that it isn’t. The continuing low-normal WBCs and low to low-normal neutrophils probably have some relation to FIV status and may call for a more aggressive therapy. Older FIV+ cats will sometimes show sustained mild or moderately low to low-normal white counts or differentials without a dramatic effect on clinical health, though in a nine to ten year old cat one might hope for better. FIV+ cats also tend statistically to develop CRF earlier than FIV- cats owing to immune-complex deposition in kidney glomerula.

13)

Cat. Thomas [m], born c.1998

Owner. Suzanne Hye, U.S.

Disease Status. AIDS

History. Thomas was adopted as a kitten, along with a female litter mate Stacy. Because of an incorrigible lack of litter box etiquette he eventually became an indoor/outdoor cat. In mid to late 2007 the interior surface of Thomas’ ear became crusty, bloody, and ulcerated. A biopsy indicated an allergy, but despite various medications and an Elizabethan collar, the sore would not heal. By July 2008 Thomas was noticeably thin and behaved in a highly depressed way. A new vet did blood work in the course of which it was found that Thomas was FIV+. Otherwise, hematology and blood chemistries were normal. L-lysine was prescribed as an “immune booster.”

Therapy. In early August, 2008, Thomas began receiving weekly subcutaneous injections of Lymphocyte T-Cell Immunomodulator (LTCI) at standard dosage. After completing a series of three weekly injections, he began a maintenance regimen of monthly injections. In recent months his injections have been increased to every three weeks.

Outcomes. A record of Thomas’s relevant blood work follows.

Date------------------7-16-08---------------9-12-08--------12-24-08--------7-5-10

Hematocrit-----------32.1%------------------30.5%---------32.6%----------20.8%(L)

WBC------------------4.4----------------------4.7--------------6.9--------------3.2(L)

Neutrophils-----------1936(L)---------------3431-----------3933------------1536(L)

Lymphocytes---------1804-------------------1034(L)-------1449-------------928(L)

Hematology. Thomas’ baseline blood work revealed no significant abnormalities in the serum chemistries. The white count (WBC) was within normal reference values, but lymphocytes were low normal (1804) and neutrophils were low (1936). Followup blood work done two weeks after completion of weekly injections showed a normalizing of neutrophils (3431) and a decline of lymphocytes to a low level (1034). December 2008 blood work shows normal WBC, neutrophils, and lymphocytes. High eosinophils (1242), the only abnormality noted, were of uncertain significance, although a connection to Thomas’ ulerated ear is possible. Eosinophilia correlates most often with allergy or parasitism. No further bloodwork was forwarded until July, 2010. This recent bloodwork shows Thomas deficient in both red and white cells, suggesting disease progression to AIDS. Serum chemistries were normal, except for a mild elevation of amylase. Clinical. By early September 2008, at the two-week point following the last of Thomas’ weekly injections, Thomas’ appetite was improved, and his earlier depression had vanished; he was active, playful, and affectionate. The owner noted an improvement in his coat, which had been dull for the past year. Although the ulcer in the ear had not healed, improvement was noted. By November, the owner noted a curious pattern, however. “He has a day once in a while where he just drags, and he even appears to have trouble climbing stairs.” Thomas’ vet could find no mechanical defects to explain the phenomenon. By December 2008, Thomas had added 4 oz to his baseline weight of 7lbs, 6oz. Initial improvement in Thomas’ ulcerated ear plateaued by November 2008 and worsened throughout 2009, being crusty and causing itching. Despite an Elizabethan collar and various antibiotic therapies IM, PO, and topically, his ear remained “scratched to hamburger”. At the end of summer 2009 he missed his LTCI injection by about 2 weeks and immediately contracted a nonspecific infection, which was successfully treated with antibiotics. In early 2010, he developed scabby keloid-like lesions at several places on his skin. Diagnosis has so far been lacking. However, in February 2010, Thomas' ongoing ear lesion was finally diagnosed as proliferative & necrotizing otitis externa, a rare condition of unknown etiology. Treatment was begun with topical 0.1% tacrolimus. Unfortunately, there was no response. At present, though active and appetent, Thomas is painfully thin at 6lbs, 5oz.

Discussion. Thomas’ low normal WBC and lymphocytes and low neutrophils prior to beginning treatment with LTCI–viewed in conjunction with his poor healing and with the lack of other apparent symptoms of a pathology–justified assigning him to the ARC category at that time. The gradual improvement in healing and demeanor and his modest weight gain–seen in conjunction with his normalized neutrophil and lymphocyte counts–seem to justify giving therapeutic credit to LTCI for improvement, although lymphocyte counts remained unimpressive and heightened somewhat the mystery of a supposedly lymphoproliferative drug that shows minimal impact on lymphocytes. The continued worsening of Thomas’ ear infection seemed to indicate an immune insufficiency that was not been addressed by LTCI. The eventual diagnosis as possibly autoimmune or allergic in origin and Thomas' episode of illness following temporary cessation of LTCI somewhat undercut that conclusion. The owner has said, “It is my personal opinion that the LTCI has been invaluable. . . . I am sure it is keeping his head above water.” However, the failure of Thomas's necrotizing otitis to respond to indicated treatment, along with the pancytopenia registered in his recent bloodwork, indicates that, at least at this point, LTCI is having diminishing impact and that Thomas' disease has progressed to AIDS. As of August, 2010, he will have been treated for two years with LTCI. Although it is impossible to know how he would have progressed without it, the owner's assessment seems a reasonable one. Regarding possible side effects, Thomas’ “draggy” days after beginning LTCI did not, according to the owner, correlate with injections; therefore, they should probably not be regarded as side effects.

14)

Cat. Tux [m], born c. 1998 No further Reports

Owner. Donna _______, U.S.

Disease Status. AIDS

History. Tux is a former stray, approximately ten years old. It is unclear when he was diagnosed FIV+. He had no significant health problems until the winter of 2007, when the owner noticed his whiskers were malformed or broken off. Earlier that year tooth removal for gingivitis occurred, which with follow-up Clindamycin was brought under control. However, in mid-2008 he seemed less active and showed seclusive behavior. In August, 2008, Tux’s owners saw that his gums were pale. Upon veterinary examination, Tux had a 103 degree fever, his kidneys felt slightly enlarged, and his blood work showed severe anemia (hematocrit 11.9) and mild neutropenia (2170) and thrombocytopenia (146). Lab report indicated nucleated red blood cells “ with extramedullary hematopoiesis or bone marrow displacement.” Tux was given Epogen (erythropoietin)and iron and was transfused later the same day. By the following day, his fever had gone and his hematocrit rebounded to 20 and white cells and platelets had normalized, although anorexia did not resolve. Subsequent testing for hemobartonella was negative.

Therapy. Tux’s initial therapeutic regimen consisted of Baytril, Epogen, and cyproheptadine for appetite stimulation. The owner added PetTabs liquid iron, B vitamins, 1/2 tab of Marrow Plus (milletia) bid, and Natural Cat Daily Senior Vitamins. On 22 August 2008, three days after the initial veterinary visit, Tux received his first injection of Lymphocyte T Cell Immunomodulator (LTCI) at standard dosage. One week later, he received a second injection. A third injection was scheduled for 5 September, but never took place. Attempts to give a number of supplements (such as lactoferrin and olive leaf extract) were unsuccessful and were abandoned.

Outcomes. Three days after being transfused and treated with Epogen and antibiotics Tux’s hematocrit had risen to 21.5. On the same day he received the first injection of LTCI. Three days following that (25 August 2008) it had risen to 22. However, his activity level and vocalizations remained depressed. On the day of his second injection of LTCI (29 August) his activity level was good, but his hematocrit had fallen to 20. The vet didn't seemed alarmed at the decrease. Following the second injection, his activity level again drooped. By 4 September he continuing to weaken and run a fever. His hematocrit was 15. The following day showed a hematocrit level of 13, an even lower neutrophil level, and corrected reticulocytes of .3%, down from 1.0% on his initial bloodwork. Lymphocytes, which had been a normal 4480 on initial blood work, had risen higher still. At this point, the owner, in consultation with her vet, elected to have Tux euthanized, the situation being judged as hopeless. On 4 September 2008, Tux was euthanized.

Discussion. LTCI does not seem to have made a notable impact on Tux’s anemia or disease process in general. There are various possible explanations. (1) The drug was inadequate. (2) The drug was tried too late in a lengthy disease process to have an impact, but might have if used earlier. (3) The drug was not inadequate, but was applied to a disease situation for which it was a poor fit. In the last regard, Tux’s veterinarian speculated that a significant rise in lymphocytes from a level of relative lymphocytosis (i.e., in relation to neutrophil percentage) may have indicated the presence of a lymphoma affecting bone-marrow. (No figure has been supplied for the rise.) Alternatively, the rise in lymphocytes could be attributed to LTCI, even though LTCI seemed to have had no hematopoietic effect on neutrophils, erythrocytes, or platelets. (It is not unprecedented for FIV+ cats to have deficiencies of cells descended from myeloid progenitor cells, but not those from lymphoid progenitos.) rThere is no clear way to choose among these possibilities. As is often the case, feline diagnosis simply isn’t as rigorous a process as human diagnosis. If Tux had cancer, the nonresponse to LTCI is not surprising. If he did not have cancer, the nonresponse was not encouraging. Post-injection depression does seem to have been a side-effect of administration.

15)

Cat. Nahla [f], born c. August, 2008

Disease Status. PGL, vertical (maternal) infection likely

Owner. Samantha Kavanagh, Ireland.

History. Nahla, a neutered female, is one of two rescued kittens adopted by the owner in October 2008. She tested positive for FIV by Elisa (Snap) at approximately five to six months old. EVL serum confirming test produced a negative result. At eight-and-one-half months, retesting by Elisa and PCR produced positive results. Both Nahla and litter mate Senna (FIV negative) experienced recurrent conjunctivitis from time of adoption, Nahla’s being worse. An opthamologist diagnosed probable chlamydia, and symptoms resolved for both cats after antibiotic therapy. Nahla, however, was found to have mild gingivitis and a cataract in one eye, and continued to experience vitritis, which was treated with steroid drops. By nine months, all symptoms had resolved. Nahla weighed approximately 4 kg at the time FIV therapy was begun.

Therapy. Beginning in March 2009, Nahla received 500 mg of evening primrose oil (EPO) daily. In June one capsule of Moducare was added to her regimen (given 1 hr prior to a meal). In July, Bovine Lactoferrin (125 mg) and Vitamin E (100 IU, lowered to 50 IU in late July), with a meals. Acetyl-L-Carnitine added in late July, but dropped a month later (because of concerns about possible incompatibility with Moducare), despite the potential for additional usefulness as a weight-loss aid. In December 2009, a probiotic was added to the treatment regimen.

Outcomes. Hematology. Nahla’s first bloodwork in July 2009 was unremarkable, save for a mild elevation of ALT and a pronounced elevation of ALP, both liver enzymes. A veterinary consultant credited the ALP to healthy bone development. Globulin was normal. WBC was normal at 7030, HCT at 44%. Neutrophil:lymphocyte ratio was inverted (N --2950, L --3510). Followup bloodwork in September 2009 found continued mild elevation of ALT and AST, as well as cholesterol. Electrolytes and BUN were mildly elevated. N:L ratio was closer to normal (N –4178, L 4083). New bloodwork done in March 2010 again found mildly elevated BUN and liver-associated values (particularly ALT). N:L ratio continued to improve, but bloodwork from different labs produced dramatically different results from the same sample regarding WBC--5700 in one case, 8890 in another. Urinalysis was unremarkable, save for a deterioration of specific gravity (USG) from 1.062 in June 2009 to 1.041 in March 2010. More extensive testing in May showed normal urine concentration. Clinical. Nahla was outwardly healthy and active with good appetite from the time of the resolution of her eye problems forward. Between March and July she gained more than .5 kg. In late July 2009, she experienced an episode of labored breathing (panting, tongue protruding) following 10 minutes of play during warm weather. Veterinary exam confirmed abnormal lung sounds. Eventual diagnosis was that symptoms were related to excess weight. By November 2009 she had lost 0.3kg in weight, going from from 4.9kg to 4.6kg. Her weight has remained there, and no further breathing difficulties have been evident. In early January 2010, Nahla contracted an infection that caused fever, vomiting, mild anorexia, lymphadenopathy, and stippling of the throat An injection of Convenia failed to resolve symptoms in short order. Following hospital care all symptoms resolved. In April a similar infection occurred and resolved more quickly with the same treatment. In May, Nahla contracted a GI infection from her litter mate Senna, but her diarrhea resolved with more difficulty than Senna's.

Discussion. Her age at the time of FIV diagnosis suggests at least the strong possibility that Nahla was FIV+ at birth or contracted it from lactation. There seems no reason to interpret her early eye difficulties as pointing to the poorer prognosis that can accompany maternal transmission of FIV. It is likely, though, that her more pronounced symptoms by contrast with her litter mate on several occasions of illness by both is related to reduced immunity. Speaking of her infection in January 2010, her vet was of the opinion that response to therapy was slow and may have been related to FIV status. Recurrent stippling on the throat in January and April 2010 suggests the possibility of a chronic viral infection perhaps related to FIV status. The significance of the breathing episode remains to be seen, but seems to be weight-related only. Inverted N:L ratios sometimes characterize phases of chronic viral infections such as FIV; however, elevated globulin, indicating hyperactive antibody production, is lacking. Whether abnormalities in serum chemistries have any long-term significance is unclear at this point. Persistent elevation in ALT is perhaps significiant. Subclinical liver abnormalities are often reported in studies of chronic FIV infection, and a cat born with FIV could be at additional risk. Although there is as yet no smoking gun suggesting advanced disease, it seems that Nahla's FIV infection has been having a noticeable impact on her health. The value of her FIV therapy to date is difficult to judge, but no ringing endorsements are in order. The therapy has featured anti-inflammatory supplements geared to quieting excessive immune activity. It is possible that a more stimulative approach is called for.

16)

Cat. Phoenix [m], born c. 1998

Owner. Aine Wellard, Ireland

Disease Status. Symptomatic, possible ARC

History. Phoenix was trapped as a stray by an animal welfare agency in late 2004. At that time he reportedly appeared lethargic, weak, malnourished, emaciated, covered in cat bites, and flea infested. Severe oral infection was noted, several teeth were removed, and FIV was diagnosed by in-house ELISA, (later owner-confirmed by PCR). Prior to adoption by the current owner, Phoenix had a history of drooling. He reacted to being stroked on any part of his body other than limbs, and when he was stroked, his head nodded and tongue flickered involuntarily. Possible hyperaesthesia (abnormal sensitivity to touch) was diagnosed. The first vet visit with the owner following adoption in July 2005 revealed a fractured left lower canine with pulp exposed and related oral infection. Tooth extraction and antibiotic therapy were successful and drooling stopped. Phoenix has always had a poor appetite, with rearrangements in dentition possibly responsible for difficulty eating many foods, particularly dry food.

Therapy. In July 2005, Phoenix began receiving 1000 mg of evening primrose oil (Epo). In October 2005, Phoenix began to receive 1 capsule of Moducare daily, added to food. In February 2006, 100 IU Vitamin E was added to the treatment regimen, and 1000 Mg EPA fish oil replaced evening primrose oil. DMG was given for approximately ten months between early and late 2007 in hope of enhancing immune response. Milk Thistle (Livertrit Plus) was begun in July 2007 in response to a rising liver enzyme, was stopped, then begun again in April 2008 when the enzyme again rose. Monthly cobalamin/B12 injections began in November 2007 in response to poor appetite and general failure to thrive. In August, 2008 the liver regimen was changed to 100 Mg S-Adenosylmethionine (SAMe) and 1 tablet of Marin for Cats (silybin + Vitamin E) daily, the latter replacing Livertrit. A five-in-five days series of injections of Feline Omega Interferon (FOI) injections was administered in January 2008 to assist recovery from pneumonia. I daily capsule of slippery elm was added to the treatment regimen in December 2009, primarily with an eye to gastric symptoms.

Outcomes. Hematology. Except for the period when Phoenix was suffering from pneumonia, CBC and differential have always been unremarkable. From 2005 to the present, elevated ALT (a liver-specific enzyme), and total protein and have been persistent findings of serum chemistries, and urea has been elevated since at least early 2007. (Total Protein was normal for the first time in July 2009.) Globulin has varied from high-normal to mild-high, cholesterol, and CK (a stress protein) have been variably elevated at least as often as not, and GLDH (another liver-specific enzyme) has been elevated once. These findings (corroborated by comments by referral vets) are consistent with possible pre-renal disease and with chronic gastrointestinal disease of uncertain etiology but clearly involving the liver. Improvement and worsening of liver values have not always paralleled outward health and clinical presentation, but have generally reflected at least term-limited response to liver-specific supplements. Despite inconsistencies in local and Glasgow-generated blood reports late in 2009, particularly with regard to creatinine and ALT, a steady drop in urine specific gravity (USG) continues to point to early-stage kidney disease. Fortekor/Benazapril was begun in December 2009 to control proteinuria.Viral Load. FIV proviral load tested at Bristol University in July 2009 reported a value of CT 30.4, corresponding to a medium proviral load. (Bristol’s PCR methodology involves identifying the number of amplification cycles necessary to detect presence of viral DNA. Cats with high proviral load are detected easily at 0-15 cycles, animals with moderate virus loads have virus detected around 25-30 cycles, and animals with low amounts of virus take up to 40 cycles.) Clinical. During the first six months in the owner’s care, Phoenix appeared generally well and active, apart from intermittent bouts of diarrhea and constipation. In February 2007, he began vomiting with gradually increasing frequency, a problem which has continued intermittently (particularly in the morning) ever since. Periods of lethargy and depression followed vomiting, but only when vomiting occurred multiple times. By July ALT had risen to 109.2 from 75.5 in April blood work (normal reference value 0-20). During 2007 Phoenix’s personality changed: he became withdrawn and less active (staying in his bed a lot of the time), and tended to avoid human contact. Vomiting episodes went from about two per month to about two per day over a four month period. When Milk Thistle (Livertrit Plus, 1 tablet daily) was begun in July 2007, vomiting subsequently decreased, and ALT dropped in November and further in January 2008. By August 2007 Phoenix had regained some lost weight and was eating well. In late August, following treatment for ocular discharge, he became depressed, lethargic, and unresponsive. He recovered quickly after sc hydration, but hydration was required periodically thereafter until March 2008. In January 2008, he contracted pneumonia, but eventually responded to antibiotics (Synulox/Clavamox and Baytril) and antiviral (FOI) therapy, and recovered, despite initial assignment of poor prognosis. Since August 2007 there have been recurring bouts of URTI which respond well to antibiotic therapy.) Following recovery, dilation of the left eye was noted. An ophthalmologist diagnosed and treated mild uveitis. The ophthalmologist (who has treated a number of fiv-infected cats) suspected a relation to FIV+ status but was unsure whether this was uncharacteristic mildness or simply an early-stage infection. In April 2008, protrusion of the eye (unrelated to the uveitis and of unknown etiology) was noted. During July and August 2008 vomiting occurred with increased frequency. Phoenix was again given Livertrit Plus from April to July (inclusive) 2008 because of a slight elevation in ALT noted in April 2008, but this time there was no response. SAMe and Marin, started in August 2008, appeared to cause cessation of vomiting and led to a healthier demeanor that continues up to the present. By September 2008 weak appetite had given way to unexplained ravenous hunger, which eventually disappeared. Continuous vomiting resumed in November, though ALT had again declined. Treatment with an antiemetic (Cerenia) was and remains transiently helpful. Between May and July 2009, liver enzymes rose and fell, independently of new treatment. In July and August 2009, a series of examinations revealed changes in the optic disc, increased dilation of the left pupil, and absence of menace response and pupillary reflex; total blindness of the left eye was diagnosed., subject to confirmation by an ophthalmologist. Recently (November 2009), an increase in ocular pressure in the left eye was noted. Between May and late July, Phoenix lost 0.4 kg of weight (4.0 > 3.6) despite normal appetite. In late July, fTLI and fPLI testing for pancreatic disease was negative and ALT had again declined. Vomiting symptoms had not, however, abated. A six-week course of Synulox/Clavamox begun in late July resolved vomiting through early September, when they resumed shortly after antibiotics were stopped. Abdominal ultrasound performed in September found a normal-appearing liver (although October bloodwork continued to find elevated ALT) but abnormalities in stomach lining. October weight showed partial rebound from July (3.6kg > 3.85 kg), possibly as a result of calorie boosting. In November 2009, Phoenix underwent exploratory laporotomy, which included a liver biopsy. Eventually, a diagnosis of mild lymphocytic-plasmacytic gastritis and moderate hepatic lipidosis with mild neutrophilic hepatitis was settled on. Whether the gastritis is purely immune-mediated or secondary to helicobacter infection is uncertain, but the positive response to the earlier course of Synulox dictated a three-month course of azithromycin begun in January 2010 with an eye to eradicating helicobacter, if it is present, as well as to treating a persistent URTI. Phoenix is currently doing very well. Possibly in response to antibiotics, slippery elm, or both, vomiting has been well-controlled and lost weight regained.

Discussion. Unresolved issues of diagnosis leave some questions about the staging of Phoenix’s FIV infection. Although liver disease is not commonly considered to have the same level of association with FIV as problems such as stomatitis, URTIs, and diarrhea, post-mortem reports of liver anomalies as common in FIV+ cats have been made, and bowel, liver, and pancreatic abnormalities are probably underappreciated as FIV-related secondary problems. It's possible that hepatic lipidosis secondary to episodes of anorexia is largely responsible for Phoenix’s liver disturbance, though this may or may not account for concurrent hepatitis. If Phoenix’s gastric disease is idiopathic rather than related to helicobacter, chronic immune-mediated inflammatory disease secondary to FIV is a possibility, lymphocytic-plasmacytic disorders having a known association with retroviral disease. Whether Phoenix's uveitis has any connection to FIV is unclear. The episode of pneumonia, along with subsequent recurring URTIs, is at least suggestive of compromised immunity. So even taking into account the absence of CBC abnormalities and improvements in outward health, it seems likely that Phoenix is somewhere in the post-asymptomatic phase of FIV infection. The ARC designation may or may not be warranted. Viral load results (and particularly a single-snapshot) are of limited value in fixing disease status. Although Phoenix’s are not inconsistent with advanced disease, a referral vet has expressed the opinion that the viral load is on the moderate-low side, that other blood results probably reflect reasonable viral control, and that FIV is having a minor effect on Phoenix's general health. FIV-specific supplements--Moducare, DMG, fish oil (and prior to that Epo), and Vitamin E--do not seem to have had a clearly beneficial impact, although there is no way to know if immune competence or clinical symptoms would have been worse without them. Liver-specific supplements appear to have been helpful, but organ-related outcomes are easier to track than immune-related. Moducare and epo/fish oil are anti-inflammatory, immune-balancing, and mildly immunosuppressive in character, but since it is not clear whether Phoenix’s stomach and liver inflammation can be accounted for by things like anorexia and helicobacter (the occurrence of which has not been specifically tied to FIV infection), it is hard to say whether these supplements are even relevant to outcomes. Elevated total protein due to elevated gammaglobulin (only part of the globulin value) is a feature of FIV-related chronic antibody production that Moducare, for instance, might be expected to address. However, increase of both beta- and gammaglobulin are also common features of liver disease. It seems likely that Feline Omega Interferon provided a helpful assist on the occasion it was given. However, it is not unusual for FIV+ cats to suffer more severely from common respiratory viruses, so whether it made the crucial difference in Phoenix’s response can’t be said with absolute certainty.

17)

Cat. Rocky [m], born c. 2006-07.

Owner. George Trainum, U.S.

Disease Status. Asymptomatic

History. Rocky was trapped as an unneutered stray in January 2009 while running with a pack of other cats. The area where Rocky was trapped was known for people abandoning cats. Given Rocky’s temperament, it’s believed he was once cared for and then abandoned. Rocky was taken to a vet within two days of being trapped. He was given his rabies and booster shots, de-wormed, de-fleaed and neutered. In April, while being treated for an ear issue, he tested FIV+ by ELISA Snap. The owner believes that Rocky likely contracted FIV in the Fall or Winter of 2008, during his period as a stray. Rocky returned to the vet in early April 2009 and was treated for tapeworm, conjunctivitis, and excessive ear wax. In mid-April he was adopted by the current owner. After adoption he became an indoor cat and was in good health up until the initiation of current therapy. In September 2009 Rocky was retested for FIV by Western Blot and was once again positive. Prior to initiating the current program, he received 500 mg of L-lysine daily, along with Omega-3 treats, both of which he continues to receive.

Therapy. In mid-August 2009 Rocky began receiving 500 mgs divided daily (soon lowered to 200 mgs) of Olive Leaf Extract (OLE), disguised in pate, 10 mg of CoQ 10 added to food, and 3 to 4 DMG treats daily (75-100 mgs). Shortly thereafter, Lactoferrin (250 mg divided daily) mixed with meals was added to his treatment regimen. In late October 2009 the dosage of L-lysine was halved and 250mg of L-Carnitine were added to the treatment regimen. Subsequently, the owner discovered a supplement that contained carnitine (250mg), DMG (50mg), and CoQ 10 (20mg) (as well as taurine, EPA, GLA, etc.), and used that instead of the first two individually. A probiotic was begun in April 2010.

Outcomes. There have been no changes in appetite, stool, or behavior since beginning the supplements. Rocky continues to be in good health. In September 2009, while being retested at the vet for FIV, Rocky also tested negative for bartonella henselae. Routine tartar build-up was the only examination finding. In October he was again taken to the vet for what again proved to be a buildup of ear wax. A March 2010 check-up found Rocky healthy in all regards.

Discussion. The continued good health of a cat that was healthy when prophylactic treatment begins proves nothing in itself. However, Rocky tolerates his supplement regimen well. "So far administration has not been an issue with Rocky. Everything mixes with his wet morning/evening meals, except for OLE which I compound to a #5 gelcap and pill with a sticky pate cat food he likes" [owner's report].

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