Manhattan Family Practice

On Hydroxychloroquine

With the political clouds hanging over the science, we, as doctors, need to make rational decisions based on evidence, facts, research, data and medical common sense. Here is what I know about viruses and Hydroxychloroquine.

The Hydroxychloroquine mechanism of action is based on inhibiting the immune overreaction of the body when confronted by an aggressor such as a collagen disease, eg Lupus, Rheumatoid arthritis, known as auto-immune disease”.  The body produces this explosion of cytokines, which is part of its natural defense mechanism, but this “self-aggression” is worse than the disease caused by the virus itself.

If the aggressor is a viral infection, then Hydroxychloroquine tablets help to reduce this cytokines explosion therefore making it less harmful to the body.

Hydroxychloroquine has been used for many decades to prevent and to treat malaria. Malaria is caused by a parasite called Plasmodium and it causes a massive immunologic response such as in auto-immune diseases or  like the one seen by a viral disease.

It has been used extensively, and in some parts of Africa there are even Chloroquine resistant plasmodium, the parasite that causes malaria.

It has also been used to prevent and treat Zika (another type of RNA virus) since 2006. It is supposed to prevent the microcephaly, a well-known complication of the Zika infection. Zikas virus is from the family of viruses known as Flaviviridae.

The Covid-19 is a Corona virus. Both the Zika and the Corona are RNA viruses. The common flu is also an RNA virus. This means you do not have permanent immunity and can contract the virus over and over, whether you had a vaccine or already had the disease.

The Zika vaccine developed years ago and tested in the Philippines failed to produce immunity and in fact produced more damage and was eventually taken off the market.

The DNA viruses as opposed to the RNA viruses, provide a permanent immunity, and examples of a DNA virus are the smallpox, herpes zoster, hepatitis A and B.

The Covid-19 vírus behavior is not well understood at this time. We are still learning about possible immunity when one gets the disease. Are the antibodies produced a proof of immunity? Is it proof that one has had the disease? How long will the antibodies be present in the body? Does it give temporary or permanent immunity? We are all waiting for scientific data regarding antibodies to this particular virus.

Antibodies, as we know, do not necessarily predict immunity. In the case of Dengue fever, another type of virus from the Flaviviridae family of RNA, once you have been infected you produce antibodies but instead of protecting you with immunity, you can be re-infected and get more sick the second time around. Then if re-infected a third time, you may develop icteríc-hemorrhagic fever and toxic shock syndrome, a very severe, sometimes fatal, form of the disease. There is a vaccine for Dengue but it is given only to someone who has already had the disease precisely to avoid a possible fatal re-infection.

So, at this juncture, it is recommended to seek personal advice from your doctor regarding the use, or not, of hydroxychloroquine.

Hydroxychloroquine, like any other medicine, will only be prescribed if considered beneficial for you and after consultation between you, the patient, and your doctor. It is not a decision based on politics or public opinion but based on medical data and reasoning by your doctor.

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