Imagine There’s No HIV
Researchers Set Sights on HIV Eradication
By Rowena Johnston, Ph.D., and Jeffrey Laurence, M.D.
December 15, 2008—Recent news reports have publicized the case of an American HIV-positive patient in Berlin, Germany, who underwent a stem cell transplant in an attempt to cure his acute leukemia. The doctors performing the transplant surgery took a critical step by recruiting a stem cell donor who had a natural, harmless mutation that made his or her cells—and now those of the young man who received the stem cell transplant—resistant to HIV infection. It has been almost two years now and, off all anti-HIV drugs, this patient has a normal T cell count and his doctors have not been able to detect HIV anywhere in his body: blood, bone marrow, lymph node, intestine, or brain.
This case will require further in-depth study to understand just what happened in this patient, who, despite the success of the transplant, remains seriously ill. And while it has reignited hope in some quarters that a cure for HIV may be possible, there are many reasons this method cannot be employed in the millions who are HIV-infected today, not least the significant risk of mortality associated with the procedure as well as the price tag, which runs into the hundreds of thousands of dollars.
Thus it is vital that amfAR’s long-term efforts to improve the effectiveness of antiretroviral therapy (ART), and our pursuit of a practical cure for HIV, continue. amfAR recently convened two think tanks on these very topics—a small gathering in September to discuss the Berlin patient and a larger meeting in November to lay out a broad research strategy that could ultimately lead to the eradication of HIV from the bodies of infected people.
Around 40 top researchers and funders active in this second area—viral eradication—gathered in Washington, D.C., to discuss a broad and complex range of issues that future research into eradication must take into account. Think tank participants, including several amfAR grantees, addressed the ability of current antiretroviral regimens, as well as boosted regimens, to suppress HIV’s capacity to replicate, and they considered the challenges of rebuilding the immune system so that it can function properly after HIV infection inflicts damage. They also pondered the new technologies that will need to be developed in order to delve deeper into the mechanisms whereby HIV infection persists in the face of both an immune response and highly effective ART. And they discussed current as well as potential strategies to purge latent reservoirs of HIV so that emerging virus can be targeted by existing drugs.
Along with the two think tanks, amfAR has taken a leadership role by sponsoring two recent grant initiatives on urgent topics confronting HIV/AIDS research: “Exploring the potential for HIV eradication” and “Optimizing the treatment of HIV infection.” For the first of these initiatives, amfAR grantees were charged with investigating reservoirs of virus within the body and the mechanisms whereby virus within these reservoirs remains latent. They were also asked to explore the potential for using existing drugs to reduce the virus to levels approaching zero or as part of a regimen that might ultimately eradicate the virus; and to study what happens during the first few weeks of infection and how those events may determine disease course.
amfAR grantee Dr. Martin Markowitz has made seminal findings about the damage associated with HIV infection that occurs in the gut during the earliest stages of infection, and the extent to which this damage may be irreversible. To read more about his findings, click here. Meanwhile, Dr. Steven Deeks has been closely monitoring a very small group of patients known as elite controllers whose HIV disease remains at bay despite never being treated. You can read more on this here. Other grantees funded as part of this initiative are searching for the hidden locations where HIV resides beyond the reach of ART, and for agents that could purge the body of HIV.
The second grant initiative, on optimizing treatment, aimed to find ways to increase the number of people being tested for HIV; to identify those who are in the acute stages of infection; to facilitate access to HIV care and adherence to treatment; to explore the full potential of existing ART; and to better understand the persistence of HIV infection and how it can be eradicated. Along these lines, amfAR grantee Dr. Jennifer Sayles is exploring the extent to which women with HIV experience stigma and how it may affect their ability to access healthcare. She has already published three papers in prominent AIDS research journals describing her findings and pointing to potential ways to address the barriers women face in dealing with their infection. You can read more about her research here.
There are numerous angles from which a potential cure for HIV can and must be approached. amfAR continues to explore every possible avenue in its quest for that cure.
Dr. Laurence is amfAR’s senior scientific consultant and Dr. Johnston is amfAR’s vice president for research.