AIDS is a disease of primary immune dysfunction caused by HIV. To date, all of the approved and proven strategies for treating HIV disease focus on crippling the virus' ability to infect and/or destroy these cells. There are no approved treatments directed toward the immune deficits and dysfunctions caused by HIV. The good news is that when HIV replication is slowed through the use of anti-HIV drugs, the immune system begins to repair itself and there is evidence of a degree of immune restoration when HIV is controlled over time.
When HIV infects the body, it infects important cells, including CD4+ T cells, which it uses as a host to reproduce. When a cell is infected, its function is decreased and when HIV reproduces it can destroy the cell. CD4+ cells are central for directing other cells to perform tasks and control infection and disease. HIV doesn't only infect and affect CD4+ cells, but these are key cells in controlling disease. CD4+ cell counts are measured as part of routine lab work to monitor for immune health. When enough CD4+ cells are infected and destroyed, the body gradually loses the ability to fight disease and a person increasingly becomes at risk for serious life-threatening conditions.
A comprehensive strategy for managing HIV infection should include a strategy to preserve and promote immune health. While in theory this is true, in practice it's much more difficult to figure out how to do this.
What Immune Strategies Are Available Today?There are several approaches to improving our immune health that are available today and can be readily incorporated into a comprehensive strategy for managing HIV for the long-term. These include good nutrition, a sound exercise plan, stress reduction/management, getting eight hours of sleep each night and drinking at least eight cups of water daily. All of these have been shown to preserve and promote immune health. A discussion of each can be found in Project Inform's material on General Health Maintenance, available through the hotline and Web site.
Other approaches, which some people might not think of readily when pondering immune health, also include skin and oral healthcare and preventive health measures.
Skin is the body's first defense against infection -- it's a physical barrier that keeps infections out. Eating well, drinking lots of water, getting rest and reducing and managing stress are all great ways to promote skin health. Diagnosing and treating skin conditions promptly is also important.
Infections often enter our body through all of the places we have openings to the outside world -- our nose, mouth and genitals to name a few. For women, when level of acidity (pH balance) in the gynecological (GYN) tract gets out of whack, the cell walls are compromised and infections are more likely. GYN conditions that increase in frequency and severity are often the first symptoms of immune compromise in women. Routine GYN care to monitor for (and treat) GYN conditions preserves and promotes immune health. Also, studies have shown that people with gum disease (gingivitis) are at higher risk for heart disease. The bacteria build up in the mouth/gums are breathed into the lungs and can compromise the heart. Regular brushing, flossing and good dental care has been shown to prevent certain kinds of heart disease. Maintaining the health of the mucosa (vaginal, anal, oral membranes) reduces risks of infection and disease which can further compromise the immune system.
One way to preserve, promote and maintain good immune health, especially in the setting of HIV infection, is to maintain good preventive health measures. This not only includes routine health screening, age-appropriate health screening and vaccines as appropriate, but also includes following safer sex guidelines and safer food handling guidelines. For more information on each of these topics, call the Project Inform hotline.
HIV becomes active (starts reproducing) when the immune system becomes active in fighting infections and disease. HIV more easily infects activated immune cells. One way to prevent the destruction of the immune system by HIV is to prevent and treat infections promptly and aggressively. This means avoiding getting the flu each year by getting a flu shot (if appropriate); avoiding new sexually transmitted infections (e.g., herpes, syphilis, bacterial infections, hepatitis viruses, etc.) by practicing safer sex; and avoiding infections that can be transmitted more casually, through food handling and preparation, drinking water, or close contact, when possible. Avoiding more casually transmitted infections can be difficult, but there are tips and guidelines available to reduce risks. This ranges from using gloves when changing cat litter if you have a pet (to prevent infection with toxoplasmosis) to getting a water filter for your sink or drinking filtered/bottled water (to help prevent the risk of cryptosporidium).
Are There Immune-Based Therapies Available?The most readily available treatment shown to improve immune health is potent combination anti-HIV therapy. Studies show that the use of potent and effective anti-HIV therapy can increase CD4+ cell count, decrease immune activation that has been associated with HIV disease progression and improve the ability of the immune system to control serious life-threatening infections. It's theorized that potent anti-HIV therapy does this by slowing the destruction of the immune system by HIV, allowing the immune system to naturally repair and strengthen itself. Increasingly anti-HIV therapy is being used later in the course of HIV infection, once significant damage to the immune system has already occurred. The primary reason for initiating anti-HIV therapy later is because of side effect concerns. Some people do opt, however, to initiate anti-HIV therapy earlier in hopes of preventing the destruction of the immune system. This is a reasonable approach, but there may be a price to pay in terms of side effects, concerns about drug resistance over time and the impact of taking medications for a very long time, perhaps ten, twenty, thirty years or more, on quality of life.
Other immune-based therapies that are not proven, but are being studied, include interleukin-2 (IL-2, Proleukin), human growth hormone (HGH, Serostim) and a variety of therapeutic HIV vaccines. This list is not exhaustive, nor does it include the varied and many immune-based therapy approaches that have been tested over time. For more information on immune-based therapies under study, call the Project Inform hotline and ask for information on "Project Immune Restoration."
Interleukin-2 is perhaps the most widely available immune-based therapy in studies for HIV. Two large international studies are underway to determine if IL-2 can improve life and extend quality of life in people with HIV. IL-2 is a naturally occurring immune chemical that potently increases the reproduction of CD4+ cells, increasing CD4+ cell counts in people using anti-HIV therapy. There is some evidence to suggest that it might also extend the lifespan of CD4+ cells. For more information on IL-2, call the Project Inform hotline.
Human Growth Hormone (HGH, Serostim) is currently approved for the treatment of HIV-associated wasting syndrome/weight loss. Recent observations that growth hormone may enhance the size and possibly the function of a very important immune organ, called the thymus, has led to a study of growth hormone for immune reconstitution in people with HIV. The thymus is an organ that lives behind the breast bone and in front of the heart. CD4+ T cells originate in bone marrow and gravitate to the thymus where they mature. (This is why they are called T cells, the T stands for thymus, or thymocyte.) The thymus is a very important organ for new T cell development. Without a properly functioning thymus, it's doubtful that a person with a severely compromised immune system could realize full immune restoration.
Therapeutic Vaccines: There are a number of different therapeutic vaccine products in studies -- a therapeutic vaccine is used for treating someone with HIV as opposed to preventing HIV. The goal of an HIV vaccine is to teach the immune system to better recognize and destroy HIV. By offering HIV vaccines to people who are already living with HIV, researchers hope to train the immune system to better control the virus. Currently all therapeutic vaccines are being studied in conjunction with the use of anti-HIV therapy.
What About Complementary or Alternative Medicine (CAMs)?The most commonly used CAMs are what are called non-pharmacologic therapies. These include energy healing, Reiki, acupuncture, acupressure, meditation, prayer, massage and guided visualization (hypnotherapy). These types of CAMs are likely not harmful and may have benefits in reducing or managing stress and improving overall well being.
Pharmacologic therapies, like vitamins, herbs and other nutritional health products are less well understood. Some may have interactions with drugs used to treat HIV infection and some may cause unwanted side effects. There are many nutritional health products which claim to have immune boosting effects, though it's unclear how they boost the immune system and if this is beneficial or harmful in the context of HIV infection. There is not a lot of research on nutritional health products in the setting of HIV infection. For more information on "Herbs, Vitamins and HIV," call the Project Inform hotline.
DiscussionIt's been difficult to devise strategies for treating the deficits in immunity as well as the immune dysfunctions that are caused by HIV infection. While HIV infects and destroys immune cells, it also seems to lead to an over activation of the immune system, which causes its own set of problems. Therefore "boosting" the immune system could worsen the problems caused by over activation and inflammation. As noted, HIV preferentially infects activated cells and boosting the immune system to a further state of activation could increase HIV reproduction and worsen the situation. Researchers in the field of immune-based therapies are therefore extremely cautious when testing new approaches to monitor for immune activation, negative impacts on HIV replication and how a given approach might be causing harm. Many if not most immune-based therapies are tested in combination with anti-HIV therapy to decrease these potential risks.
Immune-based therapies under study might seem counterintuitive to some people. For example, there have been several studies of immune suppressive therapies for treating HIV infection. If AIDS is a disease of immune deficiency, why would you suppress the immune system in order to treat it? Part of the reason that immune cells might not work so well in HIV disease is because they are over active. Like a group of school children who ate too much sugar, it's difficult for the cells to focus and be effective in the presence of all this activation. By calming or suppressing the activation it might be possible to improve immune function, even if overall numbers of cells don't increase. Also, because HIV takes over the inner working of cells in order to reproduce, by suppressing certain factors inside the cell it might be possible to cripple the ability of HIV to use the cell as a factory. It's sort of like blocking a car from using the gasoline in its tank so it won't be able to run. The delicate trick here is to figure how to do this without causing harm. Suppressing factors that HIV might need in order to reproduce can also keep the cell from functioning properly.
More is being learned about the immune system daily as new research tools are devised, but it's a slow process of learning. While information emerges the task becomes trying to understand what the information means, what to do with it and how to turn it into studies of therapeutic interventions.
This article was provided by Project Inform. It is a part of the publication Project Inform Perspective. Visit Project Inform's website to find out more about their activities, publications and services.