Aug 26, 2003
dear doc, thanks for all the info on this site. I appreciate your thorough answers and good humor. for me, and I'm sure thousands of others, it has been a great source of info and comfort.
now, pull your crystal ball out of your black bag and give me your best educated guess. What are the chances(50/50, 75/25 against, 75/25 in favor etc.) of a therapeutic vaccine being developed, in the next five years, to prolong the period that an HIVer can go without taking meds.
I realize that the meds have come a long way in the last few years, but I'm hoping that I can postpone the inevitable for as long as possible.
P.S. CD4 325, still waiting for VL but last one was 3000
Is this an unrealistic hope?
Response from Dr. Pierone
I really believe that a therapeutic vaccine will become part of HIV treatment of the future unless this strategy is leapfrogged by gene therapy. At the last Retrovirus meeting there were several proof of concept studies presented on therapeutic vaccination. In short, HIV-infected patients were given therapeutic vaccines and most showed evidence of enhanced immune response to HIV. A strategic interruption was then done and those who responded to the vaccine had a greater delay in viral rebound compared to those in whom the vaccine "did not take". Thus, these studies suggested that vaccination augments immune response and this likely translates into a measurable antiviral effect.
There are some very important caveats however. There were some mild side effects from the vaccine, and the immunologic response was very modest, especially compared to HIV meds.
Of more concern, at this same meeting, a case of HIV superinfection was reported in an individual that had been treated during acute infection with HAART and an STI protocol. He had documented broad immune response to HIV and despite this was still able to acquire infection with a closely related clade B strain of virus. So, immunologic activity and protection against HIV confers only partial protection at best.
So, to answer your question. Progress will continue to be made in therapeutic vaccine development over the next 5 years, but will probably not result in a licensed product in that time period. There may be access through clinical trials in this time period so stay tuned.
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