This session of the CROI meeting was entitled Progression of Arteriosclerosis: role of inflammation and T Cell Activation

This session of the CROI meeting was entitled Progression of Arteriosclerosis: role of inflammation and T Cell Activation

It is now becoming clear that the progression of Cardiovascular disease is associated with HIV infection. In fact arteriosclerosis, heart disease, and stroke may contribute more to mortality and death than immune suppression leading to AIDS. A person who is HIV+ who is treated earlier and maintains viral suppression for 2 years can have the same life expectancy as an HIV- person of the same age. Now it is time to work on some of the co-morbidities associated with HIV infection such as Heart disease.

The first paper demonstrated that earlier initiation of antireroviral therapy is associated with decreased vessel stiffness. Viral stiffness and subsequent clots and endothelial swelling of the arteries are associated with cardiovascular events. So the point of the study is to start treatment of HIV infection earlier to stop the process that is causing increased cardiovascular disease.

The second paper talked about the inflammation that is present in the arteries which causes endothelial swelling and subsequent cardiovascular problems. Again the object is to stop the inflammation, Antiretroviral therapy starting early can decrease the inflammation, caused by untreated HIV infection.

The third paper talked about T-cell activation and T-cell senescence in HIV infection. It is becoming apparent time and time in these sessions that the major marker to follow in HIV disease is not viral load or CD 4 count but activation of T cells. This can be measured by the markers of T cells, like CD 38 for activation and CD 28 for senescence. These are the markers that people should pay as much attention to as viral load and CD 4 count.

It is interesting that in vascular disease and cardiovascular events, blue green algae may prove to be of great benefit. Blue green algae has among its natural components L-selectin ligand, and phycocyanin. L-selectin Ligand releases adult bone marrow stem cells into the circulation, and stem cells are directed to the place of injury, in the above situation the vascular tree. In addition phycocynain, a chlorophyll agent is very anti inflammatory, and at the place of injury that HIV causes, like in the vascular tree, it cuts done on inflammation.

Blue green algae may find its greatest use in Cardiovascular disease caused by HIV, in decreasing the immune activation, the inflammation that is so prominent in all the manifestations of HIV disease, particularly cardiovascular disease, which is becoming the #1 killer of HIV+ patients.

The first session that I attended was entitled HIV Vaccines: The Path forward.

The first session that I attended was entitled HIV Vaccines: The Path forward.

This is an appropriate title for this session considering the beating that HIV vaccine researchers and vaccine planners have taken over the last 2 years. The Merck-Government (STEP) vaccine failed miserably. Why, poor planning, poor implementation, poor science, politicians involved in the trial, failure to study the behaviors of Africans, and finally the desire by the past American administration to solve the HIV/AIDS problems as a lasting legacy to George Bush. All of this failed. Dr. Anthony Fauci put a halt on all government sponsored Vaccine trials because of those failures and he recommended that we go back to the drawing board, to do basic research, to restudy the virus and the immune system. That is what Vaccine researchers are doing no with mixed success.

The first talk was given by Miller of the RV 144 vaccine update from the Thailand based vaccine trail of 2 different vaccine candidates used to vaccinate people at the same time,, the ALVACX and the AIDSVAC candidates. People were randomized to get either both of these candidate vaccines or none in the placebo arm. Thee was a large number of people that participated in Thailand, 26,700, and the trial was ;powered in the right way, but although it showed some efficacy briefly, most people would consider it a failure in protecting people from HIV.

There then was another talk analyzing the STEP vaccine trial and why people continue to analyze this failure is beyond me. This talk was a failure also.

There followed a talk on therapeutic vaccine by the ACTG termed ACTG 5197. Therapeutic vaccines are given to people who are already infected. The study showed a 1/4 log benefit in the therapeutic vaccine. Again one has to question why in this day and age of excellent antiretroivrial drugs why anyone would opt for this trial when they could opt for another antiretroviral drug if they were failing treatment.

An interesting talk followed on using dendrite cells as the vector for autologous HIV. Dendritic cells are an excellent cell in the body where the virus multiplies. So using dendrites as a vector for delivering the vaccine candidate is a good idea but again no positive results from this study.

Finally two late breading talks were given.The first used a pox-virus based HIV vaccine requiring 3 injections of this DNA vaccine. This was a phase 1 study to show safety first. Immunogenicity of this vaccine was increased with 3 injections of this DNA based vaccine. DNA vaccines are the hottest thing going to find a preventative vaccine for HIV. These people are on the right tract.

Finally there was a talk on GM-CSF for use as an adjuvant to a candidate vaccine. These also would be used with DNA as the vector. This study was done in macaque monkeys but it is something worth watching as the field of vaccinology proceeds.

All in all the data for a protective vaccine was pretty disappointing. I do not believe there will ever be a vaccine found for HIV, The virus mutates too much, there are two many different types of the HIV virus. We must look to other means of prevention.

CROI - San Francisco - Part 3

The afternoon of the Wednesday session was devoted to Supplements and Posters. The first Supplement described an extract of bananas,yes bananas. that stopped the HIV virus in culture. As of yet no clinical trials have started for people taking ARV's and bananas, but some of those macaque monkeys that don't do so well with the virus, might be interested.

Vitamin D has become a hot topic as a supplement not only for HIV- people but for HIV+ people. Vitamin D deficiency is noted in various trials to be significantly low in 40-50% of HIV infected patients and those people did significantly worse. HIV positive people, especially in areas where there is low sunlight like the northeastern United States do worse, even with effective anitretroviral therapy.

Supplementation with Vitamin D, either by tablets or by taking milk and lots of milk is helpful, not only in slowing down the virus, but in preventing the fractures that occur in people who have low vitamin D levels.

Finally there has been a great attention at this afternoon session to the fact that antiretroviral therapy, no matter how many drugs are used, will not eradicate the virus. It is going to take something like gene therapy, or a supplement such as adult bone marrow stem cell enhancer to defeat the reservoirs of HIV, most of which are in the memory T cells. The best marker down the line to see whether there has been eradication of the virus is the Pro-viral DNA assay. To eradicate the virus the pro-viral DNA will have to be 0, will not be able to rebound on the eradicating type of therapy, and eventually will have to remain 0 after whatever treatment has been chosen that eradicates the virus.

We believe we have a chance with the supplement Blue green algae of being that eradicating agent coupled with the proper antiretroviral therapy. To see if our data and our hypotheses are fulfilled we need funding from people like you who want to see and end end this pandemic. To donate to the cause you can donate on line at www.schickfoundation.org or www.schickresearch.com . You can also send a donation to The Peter Schick Foundation, 1223 Wilshire Blvd. #1007, Santa Monica California, 90403. You can call me at 1-310-394-7989 and I will answer any question you have about the funding process or about HIV in general.

What's New in Immunopathogenesis of HIV Dugast, Harvard Medical School,Hecht, UCSF Medical School, Bunnick, from the Netherlands, and Klatt et al, fr

What's New in Immunopathogenesis of HIV Dugast, Harvard Medical School,Hecht, UCSF Medical School, Bunnick, from the Netherlands, and Klatt et al, from NIH, NIAID

One of the reasons why there has been little progress in the development of a vaccine or other immune based therapies is because there has been a weak understanding of the Immunopathogenesis of HIV. In the past there has been a focus on viral load and CD 4 counts. While these markers are still important,emphasis on immune activation is becoming more and more important. It is now very obvious from these researchers, that until the ongoing immune activation because of HIV is stopped,no particular treatment or prevention will completely succeed.

The process starts and is continuing with microbial translocation of the gut From there the lamina propria of the GI tract is broken down by the HIV invasion, and microbial organisms penetrate the lumen of the gut and the circulation, The best marker of this going on is lipopolysaccharide or LPS. If LPS is high, immune activation is still going on. A second marker to follow is activated CD 4 cells, and a third marker of this process is % lymphocytes.

The process continues with the activated T lymphocytes, depleting the NK cells which previously was thought to be the most important cell in the immune system in protecting the immune system. But people are turning towards the stem cell as the cell that has possibilities of stopping this immune activation system Blue green algae tested properly with clinical trials that we are proposing and backing these trials up with immunological monitoring will to find the mechanism as to how Blue green algae enhancer of bone marrow stem cells might work.

If we can find out that mechanism, then we maybe able to use Blue green algae during many stages in the history of HIV infection. To do this the foundation needs donations to set up these clinical trials and laboratory experiments. To be a part of the process that might give a solution to the HIV pandemic, please donate on line to one of our web sites, www.schickfoundaton.org or www.schickresearch.com Alternatively you could send a check, or money order, to The Peter Schick Foundation, 1223,Wilshire Blvd. #1007, Santa Monica California, 90403. If you have any questions you can call 1-310-394-7989. I will be happy to answer any questions you might have.

Peter Schick

Chairman of the Board and Founder of the Peter Schick Foundaton

CROI - San Francisco 2010

The Meeting of CROI opened up with a young investigator session. This is a session that was well attended with over 500 young investigators including Anthony Fauci head of the CDC. The initial talk was by Richard Koup form the Vaccine and research Center of the NIAID and the NIH. As people keeping up with the field of vaccines know HIV vaccines have suffered a blow in recent years. The Merck-Government large scale trial failed a couple of years ago to offer the people who got the vaccine any protection from HIV. A hold on funding for research for Vaccines from the Government was put on hold until more basic research could be developed.

We are starting to get some of that very important Research. Focus is now on the effector Tells namely CD 8 cells. It has been known for a pretty long time that an elevation of CD 8 in people who are infected with HIV is good. These people do better with or without antiretroviral therapy. In fact the non progressors and the innate survivors of HIV infection all had elevated CD 8 levels. Now attention is being directed to CD 8 vaccines. Agents that stimulate CD 8 cells are being developed that elevated the CD 8 cells in a persons body hoping that this will offer some type of protection from HIV. The verdict is still out but the CD 8 cell is an important marker for a patient doing well in their HIV infection.

The other part of the immune system that is very important if a successful immune response is to be developed from a vaccine is neutralizing antibodies. In general the higher the neutralizing antibody the more protection from HIV, and vaccines that stimulate neutralizing antibodies are the one most likely to be candidates for protection from HIV. There are really no effective vaccines at this time that stimulates high levels of neutralizing antibody.

Finally a monoclonal antibody that blocks HIV has stimulated the interest of researchers. A lot of research is going on in this area. One thing that is certain about our foundations work with bone marrow stem cells.is we need to do find more markers namely antibodies of define the postive effect we have seen with blue green algae. We need to monitor NK cells, neutralizing antibodies, to see what effect of blue green algae has on these important immunological markers.