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Monoclonal antibodies , Passive immunotherapy?
Sep 16, 1996

What information do you have regarding monoclonal antibodies as an AIDS treatment? Do you have an opinion regarding passive immunotherapy?

Response from Dr. Cohen

Passive immunotherapy is a term for giving someone preformed antibodies. It is also called passive immunization, and is different from what we typically speak of when we talk about immunization (or vaccination), which usually means exposing the immune system to an antigen so that it will form its own antibodies in response. For example, if you take gamma globulin before foreign travel or after exposure to hepatitis A, you are getting passive immunization (you are receiving someone else's antibodies), whereas if you take the new hepatitis A vaccine, you are using active immunization; you are exposing your immune system to an inactivated form of the hepatitis A virus so that you will form your own antibodies.

In general, antibodies are not very helpful in fighting established viral infections; they are much more useful in preventing infection. For that reason, immunization (passive or active) AFTER infection is not a commonly used form of therapy for viral infections.

Initial attempts at using passive immunotherapy for HIV infection, including the use of monoclonal antibodies, were not very successful. This may be in part because HIV mutates rapidly, and can quickly find it's way around antibodies. It may also have to do with the fact that the antibody response is not the critical part of the immune response to HIV.

Recently, monoclonal antibodies have been developed that neutralize all known strains of HIV. This may at least solve the first problem, though it remains to be seen whether even these antibodies will have much effect on established infection. There is certainly great interest in using them for PREVENTION of infection. For example, they might be used in health care workers after they have been stuck by needles containing HIV-infected blood to try to prevent HIV transmission. This concept has worked in some animal studies, but it's too early to say what role monoclonal antibodies will have in the prevention or therapy of HIV.



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