Ask the Doc: False Cures and Real Breakthroughs

Q: Dear Doc, It seems that news reports that were once hot on HIV vaccines have changed to potential cures from Russian mushrooms or fungal foot creams. What's going on here?

A: My sense of what makes for HIV news is a set of three variables. It is optimally driven by what is truly newsworthy in terms of significant breakthroughs. Secondarily, it is driven by what is potentially newsworthy for its sensationalized news value. And lastly it is driven by a slow news day that says, "let's fill it with something."

HIV vaccines have the potential for breakthrough but in large part have been most disappointing. But Russian mushrooms have a certain sensationalized news value, as do fungal foot creams. And, any news article that hypes any agent as a potential cure with "?" after the word fits the "slow news day" category.

So, where do we stand? Since the onslaught of HIV in 1981 there have been four novel vaccine trial types. The first reported in 2003 showed no efficacy. The second from 2007 showed increased rates of HIV infection in those vaccinated. Not a very good outcome. The third from Thailand in 2009 showed a 31 percent reduction in acquiring HIV among a low-risk population, which is something. The forth was halted in April 2013 due to lack of efficacy.

But there was some modest protection afforded by the vaccine in the Thai trial, leading us to believe that conceptually a vaccine is possible. But building on all this information and moving forward to new vaccine candidates is clearly challenging and painstakingly slow. So, no breakthroughs mean less news value.

In the absence of real breakthroughs, we have Russian mushrooms and fungal foot creams. Neither is anywhere close to having clinical application. You can't rub on the foot cream and cure anything but a foot fungus. But for all those readers hoping for a "cure" that will magically appear, it is tempting sensational fodder for readership. Still, I never rule out serendipity in discovery, but trust that its promise more likely realizes the hope.

Potential Breakthroughs on the Horizon

Q: So, are there any real potential breakthroughs on the horizon or is it all sham?

A: There are actually some developments from vaccine research, not on the vaccines themselves but on what are called monoclonal antibodies. These antibodies come from the cells of HIV infected persons and can be used therapeutically as "immunotherapy."

What that means is that infusing (injections) these antibodies have been shown to clear the virus from the blood of infected macaques for a period of time before the virus returns, albeit in some macaques, at lower viral levels. This implies that repeated infusions must be given to control the virus.

But if you inject genes that code for the production of this antibody (in a mouse model with human tissue), HIV-1 infection was blocked from taking hold.

And while this too is not a breakthrough or a cure for anyone yet (except for the mouse), it trumps Russian mushrooms and foot creams as newsworthy, as immunotherapy already has a place in treatment in other areas of medicine, such as cancer and autoimmune disease.

Called "more than a doctor, a trusted friend" by his patients, Dr. Howard Scheiner is a true native New Yorker. He was born in the Bronx, he attended the esteemed Bronx High School of Science and City University of New York before receiving his medical education at The Mount Sinai School of Medicine. Truly a Renaissance man, in addition to his lifelong service to the medical profession, Dr. Scheiner is a published author, playwright and musical composer. Combining all his loves, he is perhaps most proud of founding "The Brent Varner Project, Inc." a charity that provides free HIV services to those in need through the Actors Fund of America.

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