There are many possible indications of use for mAb's in therapeutic settings.
We will not know for which they will be most successful until they are tested, but we can hypothesize some very valuable contributions that they can make.
Possibly the most vital contribution that mAb's can play a part in is in a prevention setting, preventing transmission of virus from one host to another. Because of the long half-life of the therapy, the tolerability, and the potential for having a limited resistance profile antibodies could be our best hope for a reasonable and realistic global prevention tool.
2. Early Infection
When a person is first infected they are in critical need of intervention, this is the period when much of their future living with HIV will be determined and it is the period when they are most infectious to others. mAb's may play a critical role in treatment for this group.
3. Set Point
The viral set point is established during early infection and determines much of the patients life-long symptom profile. Utilizing mAb's in early infection may help to lower the viral set point and reduce the need for other intervention.
4. Post Pone Therapy
Using mAb's in early intervention and lowering the set point may have an added benefit of extending, potentially for many years, the time which the body loses its ability to control viral replication on its own requring the need additional antiretroviral therapy.
It may be possible to create a cocktail of antibodies which could be sufficient to control the virus on their own, alternatively an mAb may play a role as part of a regimen of small molecules.
6. Treatment Interruption
Using antibody therapy to drive down virus low enough to acheive a sustainable long term treatment interruption may be a valuable way to employ this new tool
Any patients who are failing their therapies for one reason or another (17% at the Fenway Community Health Center, Boston) are in critical need of novel therapies to save their lives. Immune based therapies offered by monoclonal antibody treatment may be an appropriate and life saving intervention for a large number of people in need.