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Picking Dr. Cohen's mind
May 31, 2002

Dear Dr. Cohen, I have to admit I felt a bit hopeless when you mentioned the following to the person who asked you about stem cells: "even extreme methods attempting to eradicate HIV from the body, by depleting all of the CD4 cells somehow, and then replacing them with stem cells, won't work given how HIV is in many other cells in virtually every organ in our body..." In your mind, how do you think/envision are we ever going to castrate this virus? (I hate to think that I will forever be taking HAART or any antiviral, it seems to cause a lot of toxic side effects in the long run. I'd appreciate your thoughts on this. Thanks for your time.

Response from Dr. Cohen

Hard to know if we'll ever castrate this one...

It is a sobering and depressing realization to grapple with that key fact - that complete and total eradication of HIV from us after HIV has established itself in the body is very hard to accomplish. Perhaps impossible... but clearly that is far too grandiose a statement - since in just ten or so years - this disease has gone from one of inevitable immune destruction and death to one where with just a few pills once or twice a day - HIV can be controlled perhaps indefinitely. So, as you mention, the focus has been now on improving the med options - to avoid the toxicities that have been so burdensome in these first antivirals that were found. As well as exploring ways that our own immune system might at some point be able to control HIV with periods of time off of the meds.

And with these latter two approaches there is progress. Newer meds are being developed - and some do seem to have fewer toxicity concerns than the initial ones we have. For example, tenofovir/viread was recently approved in the US - and doesn't have many of the side effect concerns that were seen in some of the earlier drugs like AZT etc. Similarly, a new protease inhibitor under development called atazanavir (catchy, huh?) does not have the lipid/cholesterol increases that are common in some of the current ones. In fact, drug companies are only developing compounds that have advantages over the current crop - and so it is fair to assume that newer meds should have at least some advantages over the current meds. There is of course no guarantee that newer meds won't have their own issues in time... but there is at least evidence of progress both in terms of success and some fewer toxicity concerns.

As for time off meds - there too there is progress. There are brief interruptions studies, and longer cycle interruptions. In fact, the NIH in the US has just funded the largest study ever done in HIV - comparing standard daily med taking with a treatment interruption approach - taking meds only for as long as needed to keep CD4 counts over 250. (To learn more, click here.)

But I agree - the goal is no meds, and no interruptions - and no HIV. We are still looking. But it just ain't gonna be so easy to get there. And for many illnesses... this is the best we can do. For diabetes, high blood pressure, etc. Sometimes daily meds, or some schedule, is where we wind up. And, as with these conditions, the meds get better and better - so people can confidently live on them and do better as result.

So stay tuned... the let down of no easy cure so far can be easily balanced by noting that with just 2-4 pills a day, we can stop this sucker indefinitely...



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