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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



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