MEDICAL UPDATE: Vaccine Therapy

MEDICAL UPDATE: Vaccine Therapy

Being Alive Newsletter; July 1992
Dr. Robert Schooley and reported by Walt Senterfitt

The last approach I'll discuss is so-called vaccine therapy. This is something that many people, including myself, thought was a bit bizarre several years ago. We thought it strange that if you injected a little more inactivated virus into people who have tons of virus floating around that you could somehow elicit an immune response not present to the whole virus.

But some people, including Robert Redfield and Deborah Burke at Walter Reed, noted that both the humoral and cellular immune response was not commensurate to the amount of virus (or antigen) floating around. They speculated that if you innoculated HIV-infected people with a protein from the viral envelope, especially those with a large portion of their immune systems still intact, you could elicit a new immune response. They found that about two-thirds of their first study participants responded with new immune responses. Subsequently, they found that those classified as "responders" did better clinically than those considered "nonresponders," in terms of higher in T4 cells, and so forth.

The real question here is what's the cart and what's the horse. The most simplistic view of the results is that the vaccine enabled those who responded to it to boost their immune response and regain control of viral replication. Another, perhaps more appropriate, view is that the vaccine just identified those people whose immune response system could still identify and react to the virus and thus predicted those who were going to do better anyway.

Other studies (of several different vaccines or immunogens) are now being conducted, both within and outside of the ACTG system. Some early reports have stated that the immune response Redfield initially found in people with greater than 500 T-cells can also be found in people with much more advanced disease. The key questions remain: Does immune response to a vaccine predict a better clinical outcome? If so,what is the best immunogen?

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