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Herpes Cure Research? To Dr. HHH
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Herpes Cure Research? To Dr. HHH

Dr. Handsfield,

In a thread titled "HSV1 Exposure Concerns...Dr. Handsfield?", you say "I don't expect a cure for herpes in the next 20 years."  This was curious to me, and I'm happy to pay to post for your insights.  I understand I am only allowed two expert threads in six months, so this will be my last.

There is some fantastic Herpes research going on.  A couple highlghts:

Dr. Bryan Cullen at Duke University has found that microRNAs regulate herpes in it's latent form.  They will attempt therapy to disrupt the microRNA and wake the virus.  At that point, it'll be susceptible to Valtrex.  Potential cure.  http://mgm.duke.edu/faculty/cullen/

Professor David C. Bloom at University of Florida is using ribozymes to corrupt the herpes genetic material and shut down virus production.  It could be used to keep antibodies high, prevent recurrence and reduce or eliminate contagiousness.
http://news.ufl.edu/2009/02/03/herpes-2/

Professor David Knipe at Harvard is using HSV recombinants as vaccine candidates.  I believe this is in pre-clinical testing.
http://knipelab.med.harvard.edu/vaccine.html

And of course the GSK Herpevac trial, now complete:
http://www3.niaid.nih.gov/topics/genitalHerpes/research/herpevac/default.htm

It seems herpes is being studied very closely.  With advances in computer processing power, DNA work is becoming faster and less expensive.  And it's a huge market.  

Questions:
In your opinion, what are the biggest obstacles?  
-Difficult virus?  
-Lack of funding?  Pharma is losing its cash cows as generic HSV meds hit the market.  Wouldn't that get them excited about a new vaccine/cure profit center?  The University researchers need funding, for sure.
-Lack of interest?  Doesn't seem the case, but HSV is just an annoyance with few health implications.
-Timeline?  Do you think there WILL be a vaccine/cure, but it'll take 20 years to hit the market?
-Other?

Thanks for your insights in advance!
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I stand by my previous statement, notwithstanding the promises of DNA technology research.  In the next 2 decades I do not expect a cure for HSV, meaning a treatment that eradicates HSV from the body and thereby prevents recurrent outbreaks, subclinical shedding, and the potential for transmission.  And in response to one of your questions, I'm not all that hopeful for ever having such a therapeutic product.

The websites you cite feature promotional materials by the investigators' institutions.  If you go to the scientific literature, e.g. via the National Library of Medicine (http://www.ncbi.nlm.nih.gov/sites/entrez) and enter the names of the investigators you cite, it will be apparent that their research, although of very high quality, is very preliminary in terms of the potential for effective, safe treatment in humans.  I hope I'm wrong, but for now that is my perspective.  It is more likely that there will be additional drugs for suppressive therapy, but not curative.

HerpeVac is a preventive vaccine, not a treatment for infected people, so it's not really pertinent to this discussion. But even for prevention, it has limited promise.  It is potentially effective only in women, only against HSV-2, and not effective in women already infected with HSV-1 (i.e., half of all vaccine candidates).  Even if HerpeVac performs as well in the recently completed trial as it did in preliminary research, it is not certain it will come to market; or if it does, that it will be widely recommended by health authorities.

All the reasons you cite are partial explanations for relatively limited research in HSV treatment.  The simple fact is that although HSV infections certainly are important, most infectious disease experts believe they pale in importance compared with numerous other infections; your characterization of herpes as "an annoyance" is a common perspective.  Personally, I think that's short sighted, but for now, that's the truth of it.

Regards--  HHH, MD
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