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Fatigue and AnemiaFatigue and Anemia
          
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anemia and fatigue better -- thanks!!
Dec 31, 2002

Hey bobby-baby, you were so so right on about my tireness! I was anemic and had low testosterone and my diet/exercise program sucked. Now with the help of Procrit my anemia is resolved. Androgel has restored my one-eyed monster back to it's previous glory. I also have a personal trainer who has done wonders for my body, and self image. i'm back to being an energetic horny-hottie again! I even have a date with my trainer (a muscle stud from Oz) lined up for New Year's Eve. If this keeps up, it's certainly going to be a very excellent new year. Especially if things work out with my trainer -- He's heaven! I owe this all to you... and I'll be sending a sizable contribution to your Foundation soon. One addtional question. Could you give us a quick update on Immune-based therapies for HIV? Any news on the Remune vaccine. I know you're supposed to only answer fatigue and anemia questions here but since you are an Immunologist I thought maybe you would consent to break the rules a bit. When are you coming to town to lecture again? Maybe by then my bicepts and pecs will be as impressive as yours! Happy New Year Doc, Thunder Thighs

Response from Dr. Frascino

Hello Energized Horned-up Hottie,

You are dating your personal trainer who just happens to be a muscle stud from the land down under? Isn't that the story line from the latest Falcon video?

I'm delighted that the diet/exercise program, testosterone replacement therapy, and Procrit for your anemia have been so successful in restoring your "vitality," not to mention resurrecting the One-Eyed Monster!

Immune-based therapies are indeed one of my pet passions, but as you mention, it's not really relevant to this forum, which is dedicated to fatigue and anemia. However, let me try to at least briefly update you on some recent developments. As you know, the immune system is a critical element in HIV infection. Not only is it the organ system with primary responsibility for dealing with infection, but it is also a primary target for this virus. In recent years, we have conducted a considerable amount of research and made some significant progress toward developing a better understanding of the impact HIV has on the immune system, as well as the immune system's efforts to control HIV infection. Immunological control,particularly HIV-specific immunity, a critical aspect of our defense system. There are several strategies for boosting HIV-specific immunity using immune-based therapies.

The first strategy is expansion of the CD4+ cell pool. There are several approaches to try to accomplish this, including:

1. Interleukin-2 2. Lymphocyte transfers 3. Interleukin-7

Current status for these therapies is as follows:

1. Interleukin-2. CD4+ cell increases have been consistently noted in phase 2 clinical trials. Phase 3 trials are ongoing. The clinical significance of the increased CD4 cells is currently being evaluated. 2. Lymphocyte transfers. Only transient effects were noted in phase 2 studies. 3. Interleukin-7. This therapy is in preclinical trials.

Second, enhancement of HIV-specific immunity has been attempted by:

1. Therapeutic immunizations and passive immunity 2. Structured treatment interruptions 3. CD8+ lymphocyte transfers.

The current status of these studies is:

1. Therapeutic immunizations and passive immunity: Showed no evidence of antiviral activity with the possible exception of Remune. 2. Structured Treatment Interruptions: Showed no evidence of enhanced HIV-specific antiviral activity. 3. CD8+ lymphocyte transfers: No evidence of antiviral activity.

Third, suppression of immune activation is being explored via cyclosporin and mycophenolate. The status so far is:

1. Cyclosporin: Randomized trial data have been disappointing. 2. Mycophenolate: We are awaiting randomized data.

These are just some of the recent data. The bottom line here is that progress is being made, but we still have a long way to go. Ultimately, I'm convinced we will need to harness or stimulate the power of our own immune systems to control or conquer HIV.

Update on Remune? Well, this therapeutic vaccine, being developed by The Immune Response Corporation, has had a very rocky road in clinical development with some studies showing promise and others, not. The latest news comes from the International AIDS Conference (Barcelona, July 2002). A group of investigators from Spain presented information on a phase 2 clinical trial of the therapeutic vaccine, which was quite encouraging. They found that Remune, when compared to placebo, delayed virologic rebound and was associated with enhancement of HIV-specific immunity. The goal of therapeutic vaccines is to help those of us who are already infected to bolster our specific immune response against HIV, in essence, to try to make us into long-term non-progressors. The other piece of good news about Remune is that it seems to be effective against many different strains and subtypes of HIV. Additional studies are now being designed, so stay tuned and we'll keep you posted on developments as they evolve.

Now getting away from complicated immune-based therapies, tell us more about your date with your trainer! By the way, the Australian slang for this kind of guy is "Heaven on a stick." You just gotta love the way those Aussie boys talk! By the way Mr. Thighs, since my photo on this site is only a head shot, how do you know what my bicepts and pecs look like?

Happy Holidays.

Dr. Bob


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