Strategies for a Cure Reviewed in Vienna

July 19, 2010

By Tim Horn

True to tradition, several world-renowned key opinion leaders opened this year’s International AIDS Conference, being held July 18 to 23 in Vienna, with a detailed review of the state of the HIV epidemic. Among the speakers was Sharon Lewin, FRACP, PhD, director of the infectious diseases unit at The Alfred Hospital in Melbourne, Australia, who made a provocative call to move full-steam ahead with strategies to cure HIV.

XVIII International AIDS Conference (AIDS 2010). Opening Press Conference. Sharon Lewin, Director of the Infectious Diseases Unit at The Alfred Hospital, Professor of Medicine at Monash University in Melbourne, and Co-Director of the Centre for Virology, Burnet Institute ©IAS/Steve Forrest/Workers' Photos

Though researchers, health care providers and people living with HIV—working in tandem—have made considerable progress in the prevention, care and treatment of the virus, Lewin noted that life expectancy following HIV infection, even under the best of circumstances, remains below that of those who are HIV negative. She also noted that antiretroviral (ARV) therapy continues to bear significant side effects and that higher rates of comorbidities, such as cardiovascular disease and cancers, continue to be documented among people living with HIV. Additionally, on a global scale, for every two people started on ARV treatment, five new HIV infections occur. 

Finding a cure for HIV is feasible, Lewin noted. She illustrated the case of a Berlin patient living with HIV and acute myeloid leukemia who underwent high-dose chemotherapy and total body irradiation, followed by a stem cell transplant involving donor cells with the CCR5-delta32 deletion—cells incapable of expressing CCR5, one of the main HIV receptors on lymphocytes and macrophages. The patient, Lewin reports, has remained negative for HIV since his transplant in 2008 and has not resumed antiretroviral therapy.

There are two distinct types of cures that may be possible in people living with HIV. First there is the sterilizing cure, where the goal is to completely eliminate all HIV from the body. The second possibility is a functional cure, where HIV remains completely suppressed—but is still present—without the need for ongoing ARV treatment.

Achieving either of these goals will not be easy, Lewin said, pointing out three key scientific challenges. First and most challenging is the persistence of latent HIV infection—inactive cells harboring the virus that cannot be targeted by available ARVs. Second, there is residual replication by these cells, even when the most potent ARV regimens are used. Finally, some anatomical sites—notably the central nervous system, the gut and genital tract—are not easily reached by many of today’s ARVs.

Strategies to circumvent these obstacles are currently being explored. One possibility highlighted by Lewin, drawing upon data published by a Spanish team of researchers, involves intensifying ARV treatment. This approach showed potential promise using Merck’s Isentress (raltegravir), according to the paper published earlier this year in Nature Medicine.

Another approach is to reduce the pools of latently infected cells through earlier treatment and by using medications such as interleukin-7 and histone deacetylase inhibitors.

Another possibility is using genetic therapies, such as modifying stem cells or delivering genes using a vector, to knock out CCR5, one of two major co-receptors used by HIV to infect CD4 cells.

Lewin noted that although these particular strategies are still in the proof-of-concept stage of development, they are grounds for optimism. She also pointed out that cure-based treatment approaches will be a major theme throughout the weeklong conference.

Search: cure, eradication, CCR5, latent HIV, Lewin, Vienna, International AIDS Conference

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Previous Comments:

Michael, Toronto, 2010-08-16 23:31:45
I think Dr. Fauci and many international scientists do not have finding an HIV cure in their high priority list. One solution would be for various HIV NGOs and individuals to get together and raise some funds. Then perhaps we can hire some retired scientists around the world who will not worry about losing their license to conduct their own research into a cure. This status quo cannot continue

A. Delgado, Mexico City, 2010-08-08 22:05:38
I hear you, Carlos, I have just been diagnosed.. a month after I met the love of my life... My hopes are that there will be a cure before 10 years, the minimal amount of time that can be achieved by the current therapies... Pray to God to illuminate scientist over the world!!

Kate Krauss, Philadelphia, 2010-07-24 17:27:39
I think that treatment intensification is being taken off the table as a viable cure strategy. See our new report, "AIDS Cure Research for Everyone," at www.AIDSPolicyProject.org We also have a Cure Blog at www.aidspolicyproject.blogspot.com

bunny, aurora co, 2010-07-24 14:14:10
Why not take a person who is in remission/cured, and distill an antibiotic from their White Blood Cells. You could, then work from the antibodies created by these antibodies to develop a more powerful antibody that would prevent HIV. I don't think we will see a CURE for HIV for a long time. it is too profitable for drug companies to produce medication for this treatment. When you have a whole world to treat, and money is to be made from that treatment, why cure it. It is like war profits.

Mayanja, London, 2010-07-23 12:09:30
We ask Allah to give all Doctors the strength and wisdom to find the cure as our people are depleted on earth. Mat Allah bless you all for the good job you are doing

wale, LAGOS.NIGERIA, 2010-07-22 20:59:36
you guys are performing a wonderfull work, i just want u guys to countinue doing the right thing on how to cure this deadly illnes

Kurt, Washington, 2010-07-22 03:14:04
Whatever happened to the idea of vibrating the little suckers to death using ultrasound/laser frequencies? It does not disrupt mammalian cells. This was a real study at Arizona State University. Someday I want to step into a booth, hear a loud hum... and zap! -- the critters are toast! ;-) www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=48701&dr_cat=1

Dream Team, , 2010-07-21 22:48:09
i have a suggestion..what if you could generate a false strand of hiv(this strand is equip with ccr5 deletion process) and insert it into the body of the patient. the false strand should be like a decoy, interacts with the virus but at the same time slowly detaching it from its host. or find the right combination of pills to take to eradicate the virus. I need some feedback

bernad, zomba, 2010-07-21 10:21:47
Iam happy with the optimistic approach our doctors have taken. i believe if more reseach could be done in sub saharan Africa, good results would be achieved because this is the region hardly hit by the pandemic. i salute you

Toni, Pretoria SA, 2010-07-21 05:19:17
Congretulation to the scientist who i know spend sleeples nights to find the cure.i hope when it ready and it will be made available to eveyone i mean there are still people who die because they cant find treatement.it sounds expensive already but atleastlist then if the cure is there and expensive will be fighting a wineble bettle finding money for the cure...Big up to the scientists

Jules, Miami, FL, 2010-07-20 19:27:00
Please take a look at this... as long as this situation can be more powerful than finding a cure, there will be no cure. Gilead profit up 25%; HIV drug sales increase‎ - MarketWatch Im poz too and it's sad, but even Bill Gates decided to stay away from supporting research.

Michele, , 2010-07-19 18:41:48
How soon do u think u will be able to perfect these treatments especially the first one mentioned, and how soon will it be brought to the U.S.

Carlos Sanchez, NYC, 2010-07-19 18:14:26
I'm very excited to hear that there will be a cure, I pray to god everyday that I can one day be cured, I'm 22yrs old and I have my whole life in front of me and because of this epidemic I was denied from the military and rejected from my one love and here I stand alone filled with hope that one day I can be happy and have a normal life. Best of luck to all the scientists and researhers that are working hard to build a better tomorrow, my prayers are with you all.