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Question:I am interested in further research on Interleukin II trials. I was rejected from several trials because cd 4 counts are just below the amount to meet criteria req. for admission. I am considering paying out of pocket for the daily injections. However, my doctor and myself would like to digest as much research as possible before making that decision. Did anything come out of the conference? ThanksDr. Pavia's Response:Response: The news on IL-2 at the 4th retrovirus conference was limited. Dr. Stephen Follansbee (abstract 419) reported a small dose ranging study on 18 men on 2 nucleosides given subcutaneous IL-2 every 4 weeks in an unusual stepwise increasing fashion (The NIH study used IV dosing every 8 weeks for 5 days). Doses up to 60 million units every 28 days were "well tolerated" with about a 110 cell increase in the CD4 count, and no increase in viral load. An interesting twist was reported by the NIH group, who pre-treated patients with thalidomide or an antibody to TNF, and substantially blocked the side effects of IL-2. These were small studies and the drugs are not generally available.We are cautiously optimistic enough about IL-2 to participate in a trial right now, but I am reluctant to use it for people outside of trials because we just don't know if there is a long term clinical benefit that can justify the expense and the toxicity. The best dose is far from clear, although 5 day courses every 8 weeks seem to be working. As you know, the CD4 increases are not impressive if you start with a low CD4 count. I am guessing that you have been unable to participate in a trial because of CD4 counts below 200. Is this on maximally effective antiviral therapy (ie 3 or 4 drugs which are suppressing your viral load close to or below detection)? One ongoing trial (sponsored by Chiron) is adding subcutaneous IL-2 to standard of care antivirals. You may want to give Chiron a call to get a list of trials and study centers near you. Good luck Andrew T. Pavia, MD |
