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IL2
Sep 16, 2001

Dr Little,

You have been so kind to answer my questions in the past that I thought I would ask another and try not to trouble you too much. I would like to know what IL2 is. I have heard and read other reports indicating that it heightens one's CD4 count...is that adequate? If someone was resistent to all drugs would this work to basically keep him/her healthy until other drugs would come about? Would the body also become resistant to IL2 if it was given too many shots, thus in time the shots would not work any more? Thanks a million!

Response from Dr. Cohen

As IL2 has less to do with resistance and more to do with treatment, you may wish to come over to the treatment forum where we have reviewed IL2 information in recent postings.

In sum, IL2 can be thought of as T4 cell "growth factor" as it stimulates growth of these cells. And in so doing, increases the number of these cells floating around, and measured on our tests. It works directly on the cells themselves - so resistance to antivirals does not directly have an impact on the outcome of using this medication. Which has led several investigators over the years to use IL2 in a variety of circumstances - including, for example, when the boost in t4 counts on just antivirals is not "enough". However there remains uncertainly about when to use this medication, if at all - since it does have its fair share of toxicity - including feeling "flu-like" while taking it - which for some is manageable, while for a few can be very troubling. And there are other side effects to consider.

Now there are general concerns that HIV is activated when using IL2 so it is considered ideal to use IL2 when there is effective HIV control. Which means it may not be an ideal option for those with much resistance. However one recent small study suggested that the boost in the t4 count may be reasonable even for those not on effective antivirals, so this issue is still being defined but is one line of investigation for those in need of a boost that they can't get from antiviral meds anymore. But the biggest challenge of all is that those who need the t4 boost the most - those with t4 counts below, say 200, are the least likely to get a boost from it. Those with higher counts do respond - but those with lower counts generally don't. There is no line in the sand that makes this distinction, but the lower the count, the less the boost.

So there are now some very large international trials working to define how to best use this agent - since there are some important reasons to keep it on the map.

Hope that helps.

There is no clear evidence of resistance to the IL2 effect when given in the usual way which is an injection under the skin twice a day for five days in a row, generally every two months or so. There are alternatives - one being lower doses given daily - and this is yet another uncertainty in the use of this agent.


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