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Thanks Guys!

Sep 20, 2003

Hi Drs.

Could you shed some light on how scientists were able to make such unprecedented progress in treating HIV in such a short time? From 1987, where we were restricted to AZT and some experimental compounds to 1997 where we make the introduction of PIs and NNTIs (HUGE step). it seems we had leaps and bounds rare for medicine. I say this because it seems to take very long to develop, research, and test drugs. Years later they are released. Were HIV drugs on some type of fast track level? If so why aren't more going through the pipeline faster. I was glad to read Dr. Youngs' astute comments on Prostratin-a very promising compound with the rare award of being funded by grants of the NIH. I have heard clinical trials are to being in 2004, according to Dr. Brown. It's interesting my cousin has Crohn's and is in med school, has told me the treatments are "crude and archaic" compared with the options for HIV. I know different diseases but interesting comment.

Speaking of, what is your view on the compound in green tea EGCg, as a potential reverse transciptase inhibitor?

Third question: Why do many of the side effects vilified by some (rightfully so, initially) people subside after time? Does the bodies metabolism adapt to the drug? Thanks for your time guys keep up the good work you are inspirational.

Response from Dr. Pierone

I think one of the few fortunate aspects of the HIV epidemic was that it emerged around the same time that the field of antiviral medications was starting. So at least we knew a little something about antivirals in the 1980's and this set the stage for future advances.

We have witnessed an explosive growth in our understanding of molecular biology, virology, and scientific drug development over the last 20 years. This has led to the achievements that you mention and the transformation of AIDS from a rapid killer to a treatable disease, at least for those that can afford the medications.

I was not aware of the compound in green tea with reverse transcriptase activity. I have positive feelings about any potential compound that will give us more options to control the virus. My own bias is that antiretroviral agents designed, produced or modified by chemists in a lab (utilizing rational drug development techniques) are much more likely to be useful than chemicals produced naturally for treatment of HIV infection. But I realize that early on most effective medications came from natural sources. One of my favorite chemicals from nature is caffeine and I use it virtually every day as part of my morning ritual.

Many of the newer HIV medications are placed on a fast track by the FDA in order to make them available faster. The side effects of some medications are worst in the first days or weeks and then subside over time and there must be some specific reasons for this phenomenon, but it is hard to pin down the exact cause and I am not sure why this occurs.

To start or not, that is the question
new study - immune based

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