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no more HIV?????
Aug 9, 2007

Hi sweet Dr. Bob:

I just read a question where in your answer you mentioned about this "agresive" antiretroviral treatment for newly diagnosed that could eradicate (I am not native in english, but that sounds like "kiss good bye" to me) the virus. I am shocked!!! is this real? (well, I supose you would not joke with something like that) my brother is HIV+, he was diagnosed in January 2005, started treatment in February 2005 with Trizivir. Does this sound "newly" enough or it's too late for him to consider this other treatment already? I know trizivir doesn't sound like the best option, but when he first started treatment they tried something else (don't remember the name right now) and that gave him a huge allergic reaction. Trizivir has kept his viral load undetectable ever since and his CD4 count has been around 500. He shows no sign of lipodystrophy (or whatever you write that in english) either. So again, any chance he could go with this other treatment you mentioned? We do not live in The US, is that treatment available in Chile? Best regards, doctor. Once again, I send you a big hug and a sweet kiss.

Response from Dr. Frascino

Hi,

I would love to say we can "kiss HIV/AIDS goodbye"; however, unfortunately we aren't there yet. The report I referenced in the other question (see below) is very preliminary research and focused on folks who were very recently infected. It's important to realize that the time at which a person gets infected can be quite different from the time they get their first HIV test and find out they are HIV positive. Shortly after someone is infected, the immune system is still very healthy and the aggressive HIV drugs may have a chance of totally suppressing HIV to the point that eventually HIV could burn itself out, even the HIV hiding in the long-lived resting CD4 cells. Would this type of research apply to your brother? No, unfortunately not. That he was diagnosed in January 2005 and began treatment the next month leads me to believe he probably was infected long before his January 2005 diagnosis and already had significant immune deterioration to the point antiretroviral therapy was recommended within one month. Also, even if that was not the case and your brother did indeed contract the virus shortly before his January diagnosis, that was still 2.5 years ago. At this point, your brother is chronically infected, not recently infected.

Finally, I would advise he get a second opinion regarding Trizivir. Trizivir contains three drugs all from the same class of antivirals (nucleoside reverse transcriptase inhibitors). It has now been well proven this approach is suboptimal compared to many other available options. Despite his allergic reaction to his first regimen, there are most likely many other preferable, more potent, options available to him! Many have better side effect and toxicity profiles as well.

Give your brother a hug from me.

Dr. Bob

facts HIV PROGRESSION Jul 30, 2007

Dear Dr. Frascino!

I have aditional questions-about HIV...

Which anti hiv mechanisms have "non-progressors" , is their imune system different from others? In which way, have they cellular factors or what? Could scientists try to copy their immune response?

THANX

Your internet friend Robby (but not Williams -)))

Response from Dr. Frascino

Hi,

You're not the only one confused about that. The basic answer is that HIV can become incorporated in "resting CD4+ T cells," which are very long-lived cells. Antiretroviral drugs don't affect these cells until they are "turned on" and the process of viral replication begins. You can read about this in the archives and on related links. I will point out there is some new information presented by Tony Fauci and the NIH that suggests at least the possibility that newly infected patients treated aggressively might be able to clear their HIV infection in 3.5 to 4.5 years. I'll post some information about that below.

To answer your final question, for those of us who are chronically infected, it is felt that even on fully suppressive doses of HAART, HIV would not burn itself out for 50 to 60 years, because of the resting CD4 cell reservoir.

Dr. Bob

Early Treatment With Three Classes of Antiretrovirals Quickly Reduces Viral Loads, Study Says

May 17, 2007

Early treatment with a combination therapy that contains three classes of antiretroviral drugs can reduce viral loads quickly -- raising the possibility that HIV can be eliminated in people with already low viral loads following aggressive treatment with new drug classes -- according to study published in the June 15 issue of the Journal of Infectious Disease, Bloomberg reports.

Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, and colleagues followed seven HIV-positive people for 3.5 to 4.5 years, measuring the number of resting CD4+ T cells in which HIV remained throughout treatment. The study found that early treatment with the three-drug combination therapy reduced the number of infected resting T cells by 50% every 4.6 months. Based on the results, the researchers estimated that 7.7 years of the combination therapy could all but eliminate HIV among people who began treatment early.

Although the number of study participants who started the combination therapy early, remained on treatment for years and had low viral loads might be small, studying them "will be of considerable value in assessing the feasibility of eradication of HIV," the researchers said. According to Fauci, the next step is to see if the aggressive treatment, along with Roche's Fuzeon and Merck's Isentress, can eradicate the virus. "The first step is to see how far we can push the envelope" in terms of reducing viral loads, Fauci said, adding, "We now have a scientific basis to feel that it's at least worth pursuing it in some select patients."

Fuzeon and Isentress attack parts of HIV that are not affected by other classes of antiretrovirals, Bloomberg reports. Such drugs have the best chance of eradicating HIV because the virus likely has not mutated to develop defenses against the new medications, Fauci said. He added that the proposed study also might help physicians decide when and how to use currently available antiretrovirals. If doctors could get HIV-positive people completely off their treatment regimens, it might be worth the risk of the aggressive treatment, Fauci said. Participants already are lined up for the proposed study, according to Bloomberg. If participants' viral loads decrease to undetectable levels, researchers will stop treatment, according to Fauci. He added that participants will be monitored so they can start therapy if the virus reappears.

In a related editorial, David Margolis and Nancie Archin of the University of North Carolina-Chapel Hill write that a risk of aggressive treatment is that measurements of viral loads are not always accurate. "The few infected cells remaining might be enough to reignite infection," the authors write, adding, "And, of course, the possibility exists that HIV may rarely persist in cells other than resting T cells" (Lauerman, Bloomberg, 5/15).



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