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Just thinking, what if?
Aug 22, 2001

I have three questions I hope you can help me answer. First what do you think the chances are for a theraputic vaccine in the near future(say 6-7years)? I hear that Merck has one under development that made a lot of headlines earlier this year. I belive it was in Feb/Mar and at that time they were starting testing in humans.So do you know what phase of testing they are in development are they out of phase I? What phase are they presently in? My next question is what do you think the possibility of a cure for HIV/AIDS? I have been told that the major problem is that the virus lurks in cells in the body(resting memory cells) and that the cells last as long as we do. Could it be possible to speed up or ecellerate the aging of these cells causing them to prematurely die and thus ride the body of one of its last repositories of virus? I have also wondered if it might be possible to use medications to cause the virus to mutate so much that it becomes so weekend that it becomes less able to replicate more and more to a point where the body can mannage the virus without much fear of rebound,do you agree with this? Finnally, lately there has been much discussion in the medical community about the possible use of stem cells for practically every known alliament immaginable. Do you think that stem cells might be useful in treating HIV/AIDS? Could perhaps they be used to regenerate the immune system? or even modify it to reisist HIV? Let me also take this oppertunity to congradulate you on a well do ne effort here on this website. I have read a lot of your responses and you are doing a wonderful job! Best wishs to you!

Response from Dr. Boyle

Several HIV vaccines are in varying stages of development, and some are already in human testing. Still, the timeline for one of these actually being shown to be effective and then approved is difficult to predict. I think 5 to 10 years is a reasonable guesstimate. A number of efforts are underway to find a way to purge the viral reservoirs. Some of them involve using more potent therapy (one regimen is Kaletra (lopinavir/ritonavir) + Sustiva/Stocrin (efavirenz) + Viread (tenofovir) + Epivir (lamivudine), which decrease viral replication and prevent new infection of resting T cells. Others involve attempts at using chemotherapy, interleukins or toxin-carrying immunoglobulins to further purge the reservoirs. None of these have proven successful yet, but there is hope that one or them or a combination of them will be successul at ridding the body of HIV-infected cells. Regarding mutations, we already use the concept of decreased fitness caused by mutations to help some patients (those who already have significant resistance) but viral mutations are generally undesirable since they lead to antiretroviral resistance. Stem cells may be helpful in some respects, but if the virus is not controlled it may simply be like adding wood to a fire. Viral control remains the paramount issue, but stem cells may have a role in patients who fail to appropriately reconstitute after viral control is achieved. We are, however, a long way from that option.



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