Researchers at the XIX International AIDS Conference, held July 22-27 in Washington, D. C., presented exciting new data in the search for a cure for AIDS.
There is enormous momentum in the field and much to be hopeful about for people with AIDS and their loved ones. Although there were no huge breakthroughs, the field continues to advance quickly.
International AIDS Society President Françoise Barré-Sinoussi, Nobel Laureate and co-discoverer of HIV-1, is focused on fostering AIDS cure research and organized a two-day symposium on the cure just prior to the main conference. There is an urgent need for both funding for AIDS-cure research to exploit new opportunities and for support for AIDS-cure activism to make sure that funding, innovation and political will for a cure remain front and center for decision-makers and research funders. Here are some highlights from the conference and symposium.
Activating virus in viral reservoirs
The challenge of curing AIDS is to find a way to rid the body of any remaining HIV virus after it has been wiped out of the blood using AIDS drugs. (Having “zero viral load” means that you have killed the virus in the blood — but not in the rest of the body.) Scientists describe the HIV in the brain, gut and other areas as existing in “viral reservoirs” — areas that AIDS drugs can’t touch. Viral reservoirs were discovered about 12 years ago. But this virus isn’t active: It isn’t reproducing or infecting cells — it’s just sitting quietly (often referred to as latent virus). Since it isn’t active, it can’t be detected by the body or by AIDS drugs and killed.
Until now, activating the virus in viral reservoirs has been impossible.
But Dr. David Margolis, a researcher at the University of North Carolina Chapel Hill, has been giving a cancer drug called Vorinostat to people with AIDS in a controlled clinical trial. New data presented at the conference shows this drug is able to activate latent virus. And because Vorinostat can activate latent virus, researchers are hoping they can kill the now-activated virus with regular AIDS drugs and potentially cure people.
Margolis’ data proved that the virus in viral reservoirs can be activated. But it did not show whether that activated virus can be killed with AIDS drugs or whether people can be cured by activating and killing the latent virus. However, the ability to activate latent virus is a milestone that took 12 years to achieve.
Note: Even people with “zero viral load” have microscopic amounts of virus in their blood that can only be detected with special tests (not available in a doctor’s office). And all people with HIV have viral reservoirs — in their gut, lymph nodes, etc.
Read more here: www.thebodypro.com/content/68307/cancer-drug-flushes-out-lurking-aids-virus-study.html. Also, Nature published this scientific article: www.nature.com/nature/journal/v487/n7408/full/nature11286.html. An interview with Dr. Margolis by The AIDS Policy Project will be available here: www.aidspolicyproject.org/curewatch.
Two patients in Boston with no detectable HIV — for now
Harvard AIDS doctors and researcher Dr. Timothy Henrich presented data at the conference about two HIV-positive patients they are following who received stem-cell (bone-marrow) transplants and are now possibly HIV-free, though they are still taking AIDS drugs. They needed the risky stem-cell transplants because they also had cancer and their first two lines of drug therapy were unsuccessful in curing the cancer. They received stem cells from outside (allogenaic) donors, but those people were not born immune to AIDS, as was the situation for the Berlin Patient’s stem-cell donor. The donors for these two patients in Boston were just regular people whose bone marrow was compatible with the patients.
Usually when a patient receives a stem-cell transplant, he or she receives full-body radiation and drugs to wipe out the old immune system before receiving the new immune system from the donor. But these two patients got a new kind of preparation for the stem-cell transplant that was less intense and less toxic. Usually, people with AIDS have to stop taking their AIDS drugs during a stem-cell transplant. But because these two patients were given less toxic preparation for the transplants, they were able to stay on AIDS drugs throughout the transplant process. Perhaps because the AIDS drugs were protecting them, the new cells from the donor did not become infected with HIV.
As of now, scientists are unable to find AIDS virus in the bodies of these two people. However, the real test will come when these patients are taken off their AIDS drugs.
This experiment does not mean the two patients are cured — but it does mean that if a doctor gives a stem-cell transplant to a patient with AIDS and protects those new cells by giving the patient AIDS drugs at the same time, those cells can probably remain healthy. It will be interesting to see what happens when and if those two patients are taken off their AIDS drugs: Will the HIV come back or is it permanently gone?
To see a video of this author interviewing Henrich, go to www.aidspolicyproject.org/curewatch.
More cure-related developments
Data showed that if you can get people in primary infection onto AIDS treatment (primary infection is the intense, the flu-like symptoms you develop a few weeks after becoming infected), you are more likely to put them in a situation closer to long-term nonprogressors: They are likely to have smaller viral reservoirs and have a better prognosis than people who aren’t treated during primary infection. The trick is to realize that the person is actually in primary infection for AIDS and doesn’t have another acute infection. At that stage, it’s too early to test for HIV antibodies. So even if a person ends up in the emergency room during primary infection, the doctors may not think s/he has AIDS but may assume it’s the flu. Doctors need to be trained to presume that people having intense infections may be experiencing the primary infection of AIDS.
At the end of the conference, U.S. Reps. Barbara Lee (D-Calif.) and Jim Himes (D-Conn.) introduced a bill in the House that would provide $100 million over five years for cure research. The funding would come out of a health section of the defense budget, rather than National Institutes of Health funding. To read about House Bill 6187, visit Thomas.loc.gov. To volunteer as a lobbyist, contact this author.
Finally, the AIDS Policy Project released a report at the conference on ways to speed innovative research toward a cure. The report, “For the Win: Curing AIDS Faster,” can be read at www.aidspolicyproject.org/for_the_win_report.