To the Editor: We believe that the HIV-1 Immunogen in the study by Dr Kahn and colleagues1 should be regarded at this point in time somewhat like zidovudine. It should not be forgotten that when zidovudine was first used as monotherapy, it diminished viral load but had no effect on the eventual clinical outcome2; however it paved the way for highly active ART. We have unpublished data showing that HIV-1 Immunogen is immunogenic (which supports the limited data given by Kahn et al); however, as with all other immunomodulatory therapy so far attempted, responses induced by immunotherapy in individuals infected with HIV are only transient and appear to have no effect on final clinical outcome. Thus, the important questions are how to induce long-term HIV-specific responses and how to reverse the anergy that causes many clinical problems in individuals with HIV. Recent data from treatment interruption studies after early treatment of primary HIV infection,3 immune control in long-term nonprogressors,4 and protection from infection that has been demonstrated in groups of exposed seronegative individuals5 raise hope that it will someday be possible to provide responses that are able to control viremia in individuals with chronic HIV.
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