AIDS researchers today are talking about something almost unthinkable a few years ago: a cure. At the International AIDS Conference, research to eradicate the virus took center stage with a major presentation by a Spanish scientist on efforts to understand how the virus persists in the body and to find ways to flush it out and eliminate it entirely. The International AIDS Society, which has convened a group of experts to lead the effort, also unveiled a roadmap for priorities in cure research in the coming years.
The work has important implications: People on antiretroviral therapy may suffer serious side-effects, including cancer, liver disease and heart disease, that can shorten their lives, said Javier Martinez-Picado, PhD, a senior investigator at IrsiCaixa AIDS Research Institute in Barcelona. Moreover, the cost of maintaining people on the therapy could reach $22 billion by 2015, he said.
But work on the cure is proceeding cautiously, as scientists have gone down this path and been disappointed before, researchers Steven G. Deeks, MD, and Francoise Barre-Sinoussi, PhD, leaders of the effort, discuss in the latest issue of Nature Reviews Immunology.
"The barriers to curing HIV are real, and they may prove to be insurmountable," they write.
What makes viral eradication so challenging is the fact that the virus integrates itself into the DNA of specialized immune system cells and can remain there indefinitely without detection. Scientists are just starting to develop tests to measure these latent cells not only in the blood, but in other body tissues, such as the lymph nodes or genital tract, where they may be hiding out, Martinez-Picado said.
The next few years also will see the development of animal models to better understand viral latency, as well some small clinical trials with several drugs that work through different mechanisms. The first preliminary results emerged in March of this year, when David Margolis, MD, of the University of North Carolina at Chapel Hill, reported that the cancer drug Vorinostat could flush out latent cells. In theory, antiretrovirals then could be used to mop them up.
"Certainly, this is promising," Martinez-Picado said at today’s meeting.
One patient already stands as proof of the possibility of cure. He is the so-called Berlin Patient, an HIV-infected man who received a bone marrow transplant for leukemia from an HIV-resistant donor. Five years have passed, and today he remains entirely free of HIV.
Ruthann Richter is a Scope contributor and writer in the medical school’s communication office. She is attending the International AIDS Conference in Washington, D.C. and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.
