As the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention just closed its doors, the 5,839 AIDS researchers, scientists, clinicians, community leaders and policy experts who convened in Rome last week are assessing the results of these four days of intense discussions. Four sessions and a plenary lecture were dedicated to the search for an HIV cure, along with two satellite meetings.
Although “cure” was -until recently- a dirty word in the HIV field, it is now the focus of intense research since a first patient, who received two bone marrow transplants for leukemia, was demonstrated last year to be cured from the virus.
Despite antiretroviral therapy, HIV persists latent in some cells, the “HIV reservoirs”, which are long-lived. Consequently, each time therapy is stopped the infection rekindles.
Life-long therapy is paved of side effects, toxicities, and will rapidly be financially unbearable. An HIV cure could be “functional”, a situation where the virus does no longer replicate in the absence of drugs, or “sterilizing”, a situation where the patient gets rid of HIV.
To reach these goals, scientists need to better understand the mechanisms of HIV persistence, in which cells does HIV hide, how these cells are maintained, and to develop innovative strategies to target the virus in its reservoirs.
Great strides have already been achieved in the last few years and new drug candidates are identified in order to “purge” this reservoir. These molecules would activate dormant HIV integrated in cell genes, and allow them to die of infection or to be destroyed by the immune system. Another approach would be to generate HIV resistant cells with gene therapy.
Despite these advances, a lot remains to be done. Scientists need better animal models of persistent infection to test these new strategies, better virological tools to measure the effects of these novel approaches, intense drug screening to get a pipeline of molecules to try. Although some governmental and private agencies have recently decided to create specific budget lines for HIV cure research, much more money is needed to fit the goal.
Alain Lafeuillade, MD, PhD, Chair of the International Workshop on HIV Persistence, Reservoirs and Eradication Strategies to be held next December, was one of the HIV cure experts present in Rome last week. “We need the same kind of political will as when President Kennedy decided to put a man on the moon within a decade,” remarked Alain Lafeuillade. “Commitment for HIV cure at the top political level will only be able to open the path to success,” he added.
HIV infection currently affects more than 34 million individuals worldwide. It is estimated that 7,000 new cases of infection occur daily. Access to antiretroviral therapy is limited in resource-poor countries, where less than 40 percent of patients actually get treatment.
The cost of life-long antiretroviral therapy will reach 60 billion dollars yearly within two decades, according to experts. Finding an HIV cure would be a win-win situation, both for patients and governments.