Dear Doctor, I have just a "quick" question concerning Dr Rizzardis primary infection intervention with Cyclosporin A + HAART. You mentioned in your article that: "Cyclosporin A must be administered intravenously". When there are oral versions of CsA, I'm wondering why they can't be used? Would then MMF be a better option? If so, should there be any concerns about that MMF have issues with other antiviral treatments (e.g. herpes) With lots of thanks and respect...

Mycophenolate (MMF) is a drug that could be synergistic with some antivirals and enhance their activity. It may also accelerate the decay of latent cells that are/could be infected with HIV, thereby reducing the size of the latent reservoir. In clinical trials, it has been disappointing in producing both effects, and there is less and less enthsiasm in continuing to study it.

Cyclosporin holds out more promise in terms of limiting the size of the reservoir, especially if it were to be used in acute/early HIV infection. Although a pill form is available, IV administration allows higher levels to be achieved, and making it easier to demostrate if the approach even works. If it does, I suppose that future trials could compare pills to the IV formulation.