|Progress with Il-2
Apr 24, 2005
Dr Henry You have done research with IL-2. However after many years of research no one seems to know whether or not IL-2 helps HIV patients in the long run.
What I find shocking is how long a delay there has been in each step of learning about IL-2 in HIV infection.
In 1996 Dr. Joseph A. Kovacs and colleagues found that "increases in CD4+ T cells could be sustained for more than two years by continuing to administer IL-2 on an individualized schedule."[N Engl J Med 1996 Oct 31;335(18):1350-6].
Jacobson, et al. Proc Natl Acad Sci U S A 1996 Sep 17;93(19):10405-10 argued for low dose, continuous IL-2. In 2001 Dr Raj Gandhi MD wrote "Low dose, continuous IL-2 is well-tolerated and a randomized trial seems warranted. However, such a trial has not been published."
What progress has there been since that time?
What is holding back our knowledge of whether or not IL-2 is effective in HIV disease?
Response from Dr. Henry
With the advent of potent HIV treatment, the vast majority of patients with CD4 counts > 200 and suppressed viral levels avoid AIDS related complicaitons. In that setting, it us challenging to prove whetehr use of IL-2 to further increase CD4 cells really offers any further clinical benefit. Those trials need to follow large numbers of patients for many years to see if there is a benefit. Two such trials (SILCAAT for persons with CD4 < 350 and ESPRIT for persons with CD4 > 350) are fully enrolled so that question hopefully will be answered in the future. Potent antiretroviral therapy has been so effective that it can obscure the potential benefit of IL-2. Some small not entirely convincing studies have noted a clinical benefit to IL-2 + HAART vs HAART alone in persons with low CD4 counts (< 200). IL-2 seems somewhat less effective at raising the CD4 count in persons with low CD4 counts. Il-2 also clearly has side effects and is not inexpensive so more convincing clinical evidence of benefit is needed before its use will increase. KH
How long can this combination last?
What Can/Cannot Be Used to Reduce BP?
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