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HIV in the brain/CCR5 inhibitor
Dec 3, 2006

Hello,

I have two-and-half questions that have nothing to do with each other.

1) The first regards some recent postings about HIV entering the nervous system that have me concerned. I started medication (sustiva/truv) this year about 4 months after exposure when there was a vl of over a million. Within six weeks, the virus was undetectable (less than 50). How do I know if the virus entered my brain or spine and is now reproducing in there? How can I stop that from happening and prevent dementia?

2a) This new CCR5 thing will supposedly inhibit HIV from entering the cell. I understand that some viruses might switch to the CCRX4 receptor, or whatever it's called. But barring that, if HIV can't enter an immune cell because it's being blocked out, shouldn't it just shrivel up and die out since there's nothing for it to infect and it has not way to reproduce?

2b) I read here on this site that researchers were experimenting with a shot to treat HIV disease (not a vaccine) that will be able to be administed only once a week or even more infrequently. How would that work and how likely is that to be a successful treament strategy?

Thanks a lot.

Response from Dr. Pierone

Hello, and thanks for posting.

There is no question that HIV enters the central nervous system and can cause neurological disease if left untreated. The notion that HIV-related dementia and cognitive dysfunction develops in patients have controlled viral replication on HAART is a myth. We simply are not seeing it in the real world.

The CCR5 inhibitors are mostly a bust because of marginal efficacy combined with adverse events. That said, if circulating HIV is not able to find a cell to infect then it dies within hours to days.

I believe that Roche is working on a new form of Fuzeon which can be given once weekly instead of twice daily. There are other long-acting medications in the pipeline as well.



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