Jul 31, 2001
<< I have never been optimistic about structured treatment interuption for chronically infected patients. The data are now suggesting that the immunologic benefits are rare and inconsistent >>
Perhaps you've missed seeing Dr. Kendall Smith's work. He suggests that HIV-specific CD4 and CD8 cells live on in chronic HIV but in a compromised state. By using low-dose IL-2 during STI 16 out of 16 patients studied demonstrated HIV-specific CMI.
http://www.kendallasmith.com/il2/investigate/ -- at the bottom:
"Current Opinions in Immunology, 2001 In Press" << Thus far, antivirals have been discontinued in 16 subjects for intervals ranging from 8 weeks to > 1 year, while daily IL2 therapy has been continued. The data from the first 9 subjects were recently reported and are representative of all 16 subjects . Upon cessation of HAART all individuals have relapsed and plasma viremia recurred rapidly, within 19 3 (SEM) days. Subsequently, plasma HIV concentration increased rapidly, with a doubling time of 1.6 0.3 days. However, instead of leveling off, the HIV concentration reached a peak at ~ 4-5 weeks from the cessation of HAART, following which it declined, an average of 10-fold over the ensuing 2 weeks, reaching a "trough" by 8 weeks from the cessation of HAART. >>
Response from Dr. Pavia
I have seen some of Dr. Smith's work in abstract form. The use of IL-2 with STI, like the use of vaccines with STI is a different, and important research direction to pursue. The data for these approaches are very preliminary, in my view, but the work definitely needs to go on!
My comment dealt with the idea of STI alone in chronically infected patients for the purpose of immune boosting. I still don't think the balance of data suggests that the benefits are outweighing the adverse effects at this point.
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