Highly active antiretroviral therapy (HAART) for the treatment of individuals infected by HIV-1 is limited by high costs, drug resistance, and drug-related toxicities. This has led researchers to investigate new treatment options, including ways to boost immune responses to better control HIV. One such approach has been termed supervised treatment interruption (STI)--in which HAART is intermittently stopped once the viral load has been reduced to a low level, in order to boost natural immunity by brief exposure to the virus. The goal is to allow for the eventual discontinuation of drug treatment.

Preliminary evidence, published by Bruce Walker and his colleagues in Nature in 2000, suggested that this approach worked in persons treated in the earliest stages of acute HIV infection. HIV-1 viral loads in newly infected patients remained suppressed for a median of six months after therapy had been stopped. However, a follow up paper, published this month in PLoS Medicine by the same research group, shows that the viral load rebounded in eight of the 14 patients by one year.

"The findings are very straightforward and very important," comments Danny Douek from the Vaccine Research Center, National Institutes of Health, United States, who was not involved in the study. "In almost every case, the virus rebounded and no clinical benefit from the interruption could be determined."

Walker's team first considered the possibility of STI in 1997 after they demonstrated that HAART given to patients recently infected with HIV could protect immune cells, called T helper cells, which are normally destroyed in the earliest stages of infection. They hypothesized that early treatment of acute HIV-1 infection with HAART might boost the immune response, allowing it to control the HIV-1 infection without the need for continuous therapy. "We did not know at that time whether the T helper cells would be functional," explains Walker, who is dir
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25-Oct-2004

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