Optimal immunity to HIV - natural infection, vaccination, or both?

Article Abstract:

Generally speaking, the immune response which results from a naturally occurring infection is far stronger than that which results from vaccination. This may not be the case with HIV (human immunodeficiency virus), the AIDS virus, however. The immune response to HIV is not robust, and certainly is not great enough to control the infection. However, in an article in the June 13, 1991 issue of The New England Journal of Medicine, Redfield and colleagues described how immunization may be used to strengthen the immune response against HIV in patients who are already infected. Using a vaccine consisting of the viral protein gp160 which had been grown in bulk in genetically engineered bacteria, an increased response was measured in 19 of 30 patients tested. It is interesting to note that the patients who responded were more likely to have CD4 T-cell counts over 600 per milliliter. Furthermore, the T-cell counts of the HIV-infected patients who responded to the immunization tended to stabilize, and no increase in the amount of actual AIDS virus could be measured in the blood of these patients over a 10-month period. These results are very encouraging, but it is too soon to determine whether these promising laboratory measurements will actually translate into improved health for patients. The possibility remains that the immunization may, in the long run, actually harm the patients. Although there is, as yet, no reason to believe this will happen, several precedents exist in which immunization actually worsened the course of viral infection. Another important finding to arise from the study is the effect of increasing the number of immunizations. For patients with fewer T-cells, which indicates an immune system already fading in potency, a larger number of immunizations was more likely to elicit a successful response. This observation suggests that there may be many details of the immunization process which may be altered to optimize the response. Careful attention to the details of the immunization protocol may ultimately result in protective immunity, even for patients who are already beginning to suffer the immunological consequences of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Physiological aspects, HIV infection, HIV infections, HIV (Viruses), HIV, Vaccines

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ddI - a good start, but still Phase I

Article Abstract:

Zidovudine (AZT) is the only drug presently approved by the Food and Drug Administration for treating AIDS (acquired immunodeficiency syndrome) or people with symptoms of infection with HIV (human immunodeficiency virus, the virus associated with AIDS). This drug has several disadvantages, including toxic effects in many patients, and a decrease in effectiveness after extended use. Although its effects are clearly beneficial to many people, other drugs are needed. 2,3-dideoxyinosine (ddI) is a new antiviral agent currently under investigation that is reported to be less toxic. Two articles in the May 10, 1990 issue of The New England Journal of Medicine discuss patient results during ddI trial studies. In both studies, increases in CD4-positive T cells were seen, an important measure of an anti-HIV effect. In addition, levels of p24 antigen, an antigen (foreign substance) associated with HIV, decreased. Both of these effects occurred at the lowest dose levels of ddI. Painful peripheral neuropathy (nerve inflammation) occurred in several patients when ddI was given twice-a-day, and in only one patient when it was given once-a-day. Pancreatitis (inflammation of the pancreas), the other important side effect of ddI, was also less prevalent under the once-a-day dose regimen. However, sustained lowering of p24 antigen levels occurred in fewer patients when ddI was administered only once daily. The results of more clinical trials are necessary to establish the best dose regimen. ddI has been made available to many AIDS patients who are intolerant to zidovudine through an 'expanded access' program. Physicians should be aware of the side effects and monitor these patients closely. Final evaluation of this drug's effectiveness should await results of all research evidence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Didanosine, AIDS-related complex

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An HIV vaccine: Evolving concepts

Article Abstract:

The science and strategies in the search for an effective vaccine to control human immunodeficiency virus (HIV) infection is reviewed. Studies of HIV pathogenesis in humans and from animal models revealed that a vaccine that induces strong T-cell-mediated immune responses in the absence of broadly neutralizing antibodies might prove beneficial even if infection is not completely prevented.

United States, Science & research, T cells, AIDS vaccines

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