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Latest thoughts on possibility of eradication?
Sep 6, 2001

Hi Dr. Cohen:

I recently read a small article in TIME magazine which said that Dr. David Ho has built a mathematical model which shows that eradication is still be possible for those with regularly undetectable viral loads who take a HAART regimen that is perhaps 20 stronger than cocktails curently being used. What are your thoughts on this and where can I read about the latest state of thinking on this matter? Also, I understand that Sustiva will soon be available in a single 600mg capsule. Any word on when? Many thanks in advance!

Response from Dr. Cohen

Recently, Dr Ho and his team at the Aaron Diamond Institute in New York City have done work on defining what happens to HIV when we use the most potent combos we can create. And in the past creating more potent combos came at a price of ever more burdensome pill counts and side effects. So what they did is to try again, using some of the newer meds, which they chose based on their potency and well as overall general tolerability. They selected a four drug combination - using Epivir, Tenofovir, Sustiva, and Kaletra. (Now, they didn't suggest that these are the best four, or even the only four one could pick, or even that four is the upper limit - but it was just one first attempt to define a more potent opening move than one we routinely use.)

And so far what they've shown is that the rate of HIV decline is faster on this combo than on other four drug combos they've tested in the past. And this shows that these are more potent, and perhaps also better tolerated since their potency is only realized when people feel well enough on meds to take the next dose...

So some of the initial enthusiasm about eradication was based on the rate of decline in the amount of HIV. And the pessimism was in part fueled by more sensitive and follow up studies showing that standard combos had a limit to this suppression suggesting eradication was beyond our reach. And while no one is yet suggesting we can eradicate HIV by any means, what is clear is that one key component of attempting eradication would be more potent suppression of HIV - to better stop it from growing even at low levels - and this they appear to have shown. Whether this is enough to one day lead to eradication is much less clear... but it is a step to still work on this very important goal.

As for a one tablet Sustiva - I understand it may be available at least in the US sometime next year - perhaps early next year. We'll keep you up to date if that is changing...



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