[Immunopathogenesis and therapeutic immunization in HIV-infection]

Modern antiretroviral treatment has improved the prognosis in chronic HIV-infection dramatically during the last decade; but the treatment is expensive, the drugs are toxic, and viral resistance is a problem. An alternative approach is therapeutic immunization. This treatment aims to improve the patients' own HIV-specific immune responses and thereby control the HIV-infection and suppress disease progression.

The article reviews therapeutic immunization in chronic HIV-infection, provides a brief overview of the immunopathogenesis of AIDS, and is partly based on studies performed at Ullevål University Hospital.

Although different strategies for immune modulation in HIV-infection have shown to induce good, HIV-specific immune responses, there has been no definite documentation of clinical benefit so far. The most promising results have been obtained by immunizing patients with injections of virus-stimulated autologous dendritic cells, demonstrating a significant reduction of the viral load. The method is complex and therefore only feasible for individualised therapy in highly specialized clinics. At Ullevål University Hospital, we have in collaboration with Bionor Immuno recently conducted studies with a therapeutic immunization candidate Vacc-4x. Vacc-4x improves HIV-specific immune responses by stimulating skin dendritic cells with HIV-like peptides. Provision of efficient therapeutic immunization methods in chronic HIV-infection seems to be more realistic now than a few years ago. These methods may postpone and even reduce the need for antiretroviral treatment, and might also be beneficial if used as prophylactic immunization.