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One More!
Sep 1, 2003

Hi Dr.,

One more question for you! Do you feel future therapies will be immunologically based? I say this because, from my layman's view, the body does initially control hiv infection. While an initial acute phase can be up to ten times the base point, most see a dramatic drop in viral levels. Until, of course, the body is overwelmed.

That being said I feel the progress in attacking HIV, a particularly wily and tenacious virus, with current drug therapies, exemplifies the unprecedented progress science has made. It is just too bad to read how the perception of cocktail therapies is "hellish" because what is hell is not having an immune system. Having one is being alive, and that is not hell. Most side effects are temporary and tolerable. Moreover, the fact that many can reach undectable viral loads, even with the most sophisticated testing systems, shows how from 1993 (death sentence with just AZT) to 2003 ( managable illness with multiple treatemnt options) science has made leaps and bounds in understanding this threat called HIV. Anyway, my concern is not so much with eradicating the latent viral pockets, though this is theoretically possible from most scientists I have talked to. I am wondering if immune based therapies can allow peopel to live with the virus (as many do with many flu strains, hsv, cmv, etc.) and to not have to maintain a drug protocol. I think 2006 will be a big year for the field, we will have a lot of data about long term effects of the ARVs, as well as data pertianing to novel therapies. I remember Ho said many in the fiedl of virology were dissapointed when viral loads bounced back after discontinuing meds in the mid-late 1990s. He said they had hoped undectable would mean the virus was wiped out.

But don't you think letting our immune system, albeit a primed, souped up version, should handle the virus? Like I said earlier it appears the CD8 cells have the ability to eradicate the HIV cells.Would be the best way to deal with it?

Response from Dr. Young

Thanks for supporting my previous posting that disagreed with the hellish state of antiretroviral medications.

I agree with many of your comments-- indeed, the long-range prospects for immunological control will likely require both "traditional antiretroviral" medications and some immune modulating strategy. This is indeed the basis of the rationale for treating persons during acute HIV infection- to preserve AND train the immune system to better control the virus. I also agree with you that the idea of eradication, while attractive requires much more of therapy than the "immune-based" control that you've described. There are numerous viral and immune targets that are being explored currently-- who knows what the future will bring-- your comment on the pace of drug discovery is certainly on the mark and it will require a continued committment for drug discovery to see these tantalizing ideas tested as real drugs.

What exactly the best immune-based therapy will be remains to be seen- whether this is a vaccine-based strategy or a "small molecule". Either way, I don't think that we will be talking about decades of continuous therapy with antiretroviral medications in the years to come (maybe by 2006, no less)-- but rather strategies of immune reconstitution followed by treatment interruptions.

Thanks again, here's wishing for that perfect HIV therapy. BY



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