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Author Topic: What is the most promising treatment ?  (Read 4693 times)

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Offline John2038

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What is the most promising treatment ?
« on: October 03, 2007, 04:56:34 PM »

unfortunately newly infected, I'd like to know what are the newly most promising drugs/treatment actually tested, and when, if everything goes well, this drugs/treatment will become available.

Also what is the best drug/treatment actually available.

So I can read about.

Thank you

Offline newt

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Re: What is the most promising treatment ?
« Reply #1 on: October 03, 2007, 05:27:41 PM »
Hello

On best, there is no best, there are many proven treatments, the state of the art at the moment, supported by many studies and many years follow up, for people with no resistance to the meds, is a combination of 2 nukes and either a non-nuke (Sustiva, Viramune) or a boosted PI (Reyataz, Kaletra, Lexiva, Invirase).  Best...it really does depend what suits you. Many drug mixtures are effective at suppressing the virus and allowing your immune system to recover. The nuke AZT is kinda out at the moment but has its value on occasions, so tenofovir  (viread) based combos or abacavir (Ziagen) based pairs are the norm, and work very well in most cases.

On best forthcoming, well, integrase inhibitors looks hot, but there are questions to be answered here about durability. Some of the immunological approaches show promise (but don't get enough reseach funds I reckon).

When I was diagnosed there was just Kaletra and Crixivan PI wise, now we have 4 suitable for first-line therapy and Crix is generally out...and more besides plus entry/integrase inhibitors and new drugs in the pipline.  The standard nukes were AZT and 2TC, sometimes ddI but I started on FTC and Viread, which were in research when I got the damn bug, things move relatively fast, and although the target in the viral life cycle may not change, each generation of drugs gets better.

 -matt
"The object is to be a well patient, not a good patient"

Offline Customer

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Re: What is the most promising treatment ?
« Reply #2 on: October 03, 2007, 05:51:16 PM »
The most promising therapies are based on genetic manipulation of patients T-cells (or stem cells in bone marrow).

http://www.virxsys.com/pages/human-therapies/product-pipeline.php

These methods aim to introduce an HIV-resistant T-cell strain to the human body. The environment where all T-cells live is a hostile environment where these genetically altered T-cells  have an evolutionary advantage over the non-manipulated T-cells. As time goes on, they will divide and multiply and hopefully they will become the dominant T-cell strain who is able to supress or  even eradicate HIV infection.
« Last Edit: October 03, 2007, 06:00:56 PM by Customer »

Offline newt

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Re: What is the most promising treatment ?
« Reply #3 on: October 03, 2007, 06:06:44 PM »
Quote
The most promising therapies are based on genetic manipulation of patients T-cells (or stem cells in bone marrow).

I am interested to hear the cast iron justification of the phrase "The most promising" (my emphasis) ... (but not waiting around). I agree this is an interesting line of enquiry.  But how many promising agents have stumbled at phase 2 trials? Many... How difficult is stem cell engineering? Very.

- matt
"The object is to be a well patient, not a good patient"

Offline risred1

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Re: What is the most promising treatment ?
« Reply #4 on: October 04, 2007, 02:44:03 AM »
Tricky Stuff that genetic engineering.

replacing segments of HIV RNA that integrate into the CD4 cell and prevent HIV replication sounds like a really interesting idea, because it is. Unfortunately, they are going to be inserted into DNA strands in our Cells, Which leaves the big question, one DNA is altered, what can go wrong?

While I'm sure the science is pretty solid, prior attempts working with techniques that use Viruses to alter our DNA have not worked. Yet!

I am hopeful, but I am also thinking that this approach is going to require alot of study. And I will not be surprised at all that for some, there may be some very serious issues presenting themselves.

Hope for the best!
risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

Offline Customer

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Re: What is the most promising treatment ?
« Reply #5 on: October 04, 2007, 11:51:47 AM »
HIV RNA is converted to DNA and then integrated to host cell DNA. That means that you have millions of HIV infected T-cells in your veins whose DNA has been altered by HIV. That happens all the time.
Why should this "engineered RNA" be more dangerous than HIV-RNA????

Offline Customer

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Re: What is the most promising treatment ?
« Reply #6 on: October 04, 2007, 11:56:58 AM »
Most promising was used because only these techniques address the root cause: HIV's ability to attack the "security guards" of immune system, the T-cells.


Offline megasept

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Re: What is the most promising treatment ?
« Reply #7 on: October 06, 2007, 07:40:35 PM »
unfortunately newly infected, I'd like to know what are the newly most promising drugs/treatment actually tested, and when, if everything goes well, this drugs/treatment will become available.

Also what is the best drug/treatment actually available...

I'd love to be re-engineered genetically...Meanwhile integrase (there may be more than one trial formula) has worked miracles with a friend (AIDS for 20 years, now 11 CD4 instead of 4 and a massive VL dropped to undetectable). Not so coincidentally, my MD/researcher and colleagues will be prescribing integrase as early as the end of this year to all kinds of patients (ie resistant or nonresistant). Unless I learn something bad in the interim, I'll be taking it soon myself. Newt might know how it works. Me: I never trouble myself with the basic science (Maybe I should). I suppose integrase is the "state of the art" for the moment.

As for when to take meds I follow the <350 CD4 and/OR >100k VL parameters, which is why I haven't been on any meds for the last 6 years, but will be in 2008. If someone newly converted with great #s holds off starting ARV, as I suggest,  then they could take integrase or whatever improvements or alternatives are down the pipeline. Almost ten years of little beyond repackaging combos and hype about how few pills to take (the least important issue of all) to take daily, the meds are finally improving again.

 8)  -megasept


Offline megasept

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  • Steven here...
repost in error. sorry.
« Reply #8 on: October 06, 2007, 07:44:22 PM »
repost in error. sorry.

Offline newt

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Re: What is the most promising treatment ?
« Reply #9 on: October 07, 2007, 04:31:04 AM »
HIV uses CD4 cells as factories to make hundreds of copies of itself. This has several steps. 
Different drugs work at different stages of the HIV life cycle.

Once HIV has attached itself and broken into a CD4 cell, the viral RNA is snipped up and recombined to make some DNA. This has to get into your CD4 cell's DNA to make new, complete HIV viruses. Integrase is the protein structure needed to insert the HIV DNA into your own cell's DNA. Therefore blocking integrase prevents HIV getting into your cell's DNA and reproducing itself.

The main targets for treatment are:

  • Entry inhibitors work by stopping HIV getting into the CD4 cell. Eg the drugs T-20/Fuseon and NEW! CCR5 inhibitors
  • Nukes and non-nukes work by stopping one of the main ways HIV reproduces inside the CD4 cell. Eg Viramune, Sustiva, AZT, Truvada, 3TC etc
  • Integrase inhibitors work by stopping HIV from being integrated into the CD4 cell's DNA (genetic material). NEW! Eg Raltegravir
  • Protease inhibitors work by stopping any new HIV material from being cut into smaller, managable proteins to construct new, complete viruses. Eg Kaletra, Reyataz etc
  • Budding inhibitors work by making new HIV that leaves the cell unable to infect new cells. INVESTIGATIONAL

- matt

Diagram from "Treatment Training for Advocates" online manual, courtesy of HIV i-Base.

Edited for spelling.

[attachment deleted by admin]
« Last Edit: October 08, 2007, 03:05:40 AM by newt »
"The object is to be a well patient, not a good patient"

Offline megasept

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Re: What is the most promising treatment ?
« Reply #10 on: October 07, 2007, 02:07:55 PM »
HIV uses CD4 cells as factories to make hundreds of copies of itself. This has several steps. 
Different drugs work at different stages of the HIV life cycle.

  • Integrase inhibitors work by stopping HIV from being integrated into the CD4 cell's DNA (genetic material). NEW! Eg Raltegravir
- matt


I guess if I am going resume ARV then I could manage to learn a one-sentence explanation of how the med functions in my system. Once again Matt, thanks for the info!

 8)  -megasept

Offline aztecan

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Re: What is the most promising treatment ?
« Reply #11 on: October 07, 2007, 09:20:44 PM »
Hey John,

Since my learned colleagues here have already commented on those meds still in the working stage, I will comment on the latter of your questions.

"Also what is the best drug/treatment actually available."

The answer is whichever of the combos works best for you. I know that sounds simplistic, but the bottom isn't which is the drug du jour, but which you tolerate best and which works for you.

Newt mentioned the oft-maligned AZT. True, some people have a hard time taking it. I, on the other had, took it for more than a decade before any side effects showed up and those were probably a result of the Crixivan I was taking rather than the AZT/3TC I continue to take.

So, it will be up to you and your doc to find the best combo for you starting with the meds considered "first line" when the time comes for you to start meds.

Things are getting better as time passes and many of the new meds aren't quite as harsh as some of the older ones, as far as we know.

So, just hang in there and take it a day at a time.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline John2038

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Re: What is the most promising treatment ?
« Reply #12 on: October 08, 2007, 01:40:30 PM »
The most promising therapies are based on genetic manipulation of patients T-cells (or stem cells in bone marrow).

http://www.virxsys.com/pages/human-therapies/product-pipeline.php

As time goes on, they will divide and multiply and hopefully they will become the dominant T-cell strain who is able to suppress or  even eradicate HIV infection.


Lot of hops. I there a chance to see this treatment to become available ? When ?


About the existing drugs:

Can we say today that in general the time before a treatment stop to work for someone, is greater than the time to get a new treatment ?
So that there is still a way to continue the treatment.

Is the treatment you are taking specific to the HIV type (HIV 1 or 2, and subclasses) or are they independent of the type ?

Thanks
« Last Edit: October 08, 2007, 04:45:27 PM by John2038 »

Offline Customer

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Re: What is the most promising treatment ?
« Reply #13 on: October 09, 2007, 11:52:41 AM »
I do not know when this particular Virxsys therapy will be available...  but the approach used in it is essential for treating HIV with easiness and next to zero side-effects. We need those HIV resistant T-Cells no matter what.

I think with good drug-adherence you could stay on a drug for 5-10 years or so.
You can look at the HAART development pipeline here:

http://www.thebody.com/content/treat/art1749.html

FDA approval takes years, but sometimes promising products are approved faster than usual.


Here is more about Virxsys. Its in phase 2... Looks very promising

http://www.genengnews.com/articles/chitem.aspx?aid=2119

All patients showed stable or decreased viral loads as well as stable or increased immune responses to HIV antigens. Four of the five had stable or increased CD4 T cells. Some patients have maintained these positive outcomes for up to three years, and the genetically modified CD4 T cells remain in circulation. A Phase II study is under way in 40 chronic HIV patients to further establish the safety and tolerability of VRX496 and to determine the optimal dose.


Phase II is starting anytime soon. I bet this drug will yield even better results when used in combanation with HAART. I think it should be used like this:
1) First you introduce Virxsys T-cells to the patient. As time goes on, HIV infects and kills original T-cells, but Virxsys T-cells survive. Thus they become more common in patients blood (T-cell evolution)
2) Then HAART is used to bring down viral load. 
3) Virxsys T-cells have the ability to keep viral load low, and inhibit HIV from rebounding.

The patient could stay off med for years. Doesn't that sound promising?

« Last Edit: October 09, 2007, 06:18:13 PM by Customer »

Offline John2038

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Re: What is the most promising treatment ?
« Reply #14 on: October 13, 2007, 04:21:05 AM »

Yes :)

They don't says in the article (Virxsys) how long time will probably be the phase II.

I had read somewhere that despite the similitude with our genes, the monkeys are resistant to the HIV.
Are some companies looking in this direction as well ?

I pledge glory those who will find the cure. Heroes for ever. Huge glory.

Offline John2038

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Re: What is the most promising treatment ?
« Reply #15 on: October 20, 2007, 06:41:19 AM »
Hi,

what do you think about the KP-146 ?
Very few people are talking about it. Any reasons ? Can it be considered as a very promising treatment, based on the way it works ?

Source: http://www.thebody.com/content/art43529.html?mtrk=3440519

Offline Customer

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Re: What is the most promising treatment ?
« Reply #16 on: October 21, 2007, 04:25:55 AM »
KP1461 has already been discussed in this thread:
http://forums.poz.com/index.php?topic=13404.0

It is "super-effective HAART". There are several applications where it probably will be used, intermittent treatment and PEP.
However, it cannot destroy latently infected cells. So it is not a cure. 
« Last Edit: October 21, 2007, 04:33:30 AM by Customer »

 


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