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Treatment Interruption Research: The Trial Most Needed Now

By David Scondras
AIDS Treatment News #320

aidsresearch.jpg - 4.88 K "We need to support trials that give a person the best chance to be able to stay off drugs for the longest possible time."

Note: Treatment activist David Scondras, of Search for a Cure in Boston, outlined a research proposal in a May 27 email to the Treatment list.(1)

We also talked with him for additional information for this article. Essentially he is outlining a comprehensive approach which brings together the various tools which may help the immune system improve its control of HIV.

The problem is that it is hard to organize and fund a comprehensive trial; instead we get fragmented trials as different companies, groups, and individuals pursue their own agendas. JSJ

If you look at the ideas so far on how to get immune control of HIV, and put them together, they are not antagonistic. You could use antiretrovirals to suppress the virus, wait until there are naive cells, and then use an immunogen like Remune(TM), or a DNA vaccine, to cause replication of the naive cells which recognize peptides associated with HIV.

When that has been done well, use IL-2 to copy all of the clones, including those which recognize HIV, until there is a significant rise in LPA (lymphoproliferative assay, a measure of immune function) in response to HIV.

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Then set a viral load threshold, low enough that one is comfortable it will not wipe out those clones; interrupt antiretroviral therapy, and go back on therapy when the viral rebound reaches that pre-determined threshold.

See if long cycles of interruption followed by therapy when needed can prolong the time a person can be drug-free and still below the viral threshold.

A similar companion trial could test a regimen which is easier to take, such as ddI plus hydroxyurea, instead of the treatment interruption, to see if a simpler therapy is enough to keep the virus suppressed, after this effort to reconstitute the immune response against HIV.

This is not the only trial that should be done; far from it. But it is the one trial that must be done. We need to support trials that give a person the best chance to be able to stay off drugs for the longest possible time.


1. For information about joining the Treatment list, send email to listproc@CritPath.Org, with "info treatment" (without the quote marks) in line 1.

Copyright 1999 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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