• Immunomodulation of Chronic HIV-1 Infection: Impact of HAART, Interleukin-2 and/or an Inactivated gp120-Depleted HIV-1 Immunogen (REMUNE) (Poster 349)
  Authored by G. Hardy, N. Imami, A. Sullivan, M. Nelson, C. Burton, R. Moss, B. Gazzard, and F.Gotch
  View the original abstract

For some time it has been apparent that antiretroviral therapy alone will not "cure" HIV disease. This is due to a number of factors, including the poor immune response to HIV and the persistence of HIV reservoirs, which have such a slow rate of decay that by some recent calculations it may take as long as 73 years for HIV to be eliminated from these sites. As a result, a search has been mounted to find agents that might be effective at stimulating the immune system to control HIV replication and activating the latent memory cells that form the reservoirs for HIV persistence so that they can be eliminated.

This study evaluated the effectiveness of three agents that some research has indicated may individually or jointly play a role in stimulating immune control of HIV replication and activation of the cells which form the latent viral reservoirs. Forty patients with a mean baseline CD4+ cell count of 286 cells/mL were treated with highly active antiretroviral therapy (HAART) for 16 weeks before being randomized to be given: (1) HAART alone, or (2) HAART plus IL-2, or (3) HAART plus IL-2 plus REMUNE, or (4) HAART plus REMUNE.

The authors found, as others have before, that HAART alone leads to significant immune reconstitution but does not lead to the development of any HIV-specific immune response. The addition of REMUNE did lead to the development of some degree of HIV-specific immunity in some patients. The addition of IL-2 reduced the number of REMUNE doses necessary to achieve this effect and increased the number of HIV antigens to which responses were induced. As expected, the addition of IL-2, with or without REMUNE, significantly increased CD4+ cell counts and also, to a limited extent, increased HIV-specific immunity.

From this data, the authors conclude that HIV-specific immune responses can be induced in HIV-infected patients on HAART by using it with either IL-2 or REMUNE, and that HAART, IL-2, and REMUNE are most effective at increasing immune responsiveness to HIV when they are given in combination. If further, larger trials confirm their findings, this may be a very effective method for stimulating immune responses to HIV and inducing an immune state similar to that of long-term nonprogressors. This possibility allows for some hope that HIV therapy will not need to be lifelong and that a "cure" of HIV may be possible in some patients.