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Bruce Walker, vaccines and immune recovery

Posted: Jul 28, 2002

QUESTION:

One of the more disturbing revelations coming out of the International AIDS Conference (in my opinion, at least) was the presentation on immune recover by Bruce Walker. A patient -- seemingly on his way to becoming a long-term non-progressor -- manages to superinfect himself with a strain of HIV highly similar to the first, and it destroys all of the gains Walker had made with his 'hit hard, hit early, stop quickly' HAART method. My question for either of you is: What does this mean for immune recovery? What does this do to the search for a vaccine -- preventive or otherwise -- that constantly seems to hit a new setback? Is there any kind of research being done that sheds hope on the possibility of creating a treatment that can mutate -with- a virus, or that can strike a wide range of strains simultaneously?


  

RESPONSE FROM:   

    Yes, this presentation was felt by many to be one of a few showing superinfection might occur - and this does give pause to the hopes for a vaccine.

    So - as you describe, what is clear is that there are now a few people who have achieved some "stalemate" with one strain of HIV, and then in time another can emerge, that the immune system is not controlling nearly as well as the first strain. And by history, there is good reason to suspect that this is "reinfection" -- rather than the emergence of a second strain that was there from the beginning, but for reasons unknown, stayed quiet until a future point.

    The implication are varied however. First, is that despite a fair bit of looking, it has been hard to find cases such as this. So while it may be that this does occur, it also may be that it is an unlikely outcome. Meaning that a vaccine might work well, for example, but not perfectly. Or that the STI approaches by Walker and others can work, but are not guaranteed to be protective against all strains forever, so that the immune system can hold its own up to a point.

    So perhaps another way to look at this is that there is still hope for the "hit early" approaches to stimulate a protective immune response - but that HIV remains capable of jumping this hurdle - implying that this stalemate will require ongoing maintenance on our part to be durable. And similarly for a vaccine - it may help, but there may be some who become infected despite one. As with post exposure prophylaxis - it may work, but clearly there are some who have been infected despite this. Partial success seems plausible, even though 100% protection is the elusive goal.

    Hope that's helpful.




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