Future milestones of HIV treatment and cure

Prakash Tyagi, CNS Correspondent 
“How come we have been able to bring everything that life needs into one mobile phone device and can keep it in our pockets, but can not find a cure for HIV,” asked a young man to Dr. Francoise Barre-Sinnousi, Nobel Laureate and Co Chair of the ongoing 20th International AIDS Conference in Melbourne.

Dr. Sinnousi explained the challenges to the young man HIV science is facing. The prevention and cure of HIV remains to be one of the most sought after medical research issues of all times. Significant advances have been made but the goal of preventing or curing HIV still seems to be far.

Dr Anthony Fauci of the National Institute of Allergy and Infectious Diseases, US explained the research progress at AIDS 2014 in Melbourne. “Eradicating the HIV reservoirs in human body and HIV vaccinology are two broad platforms that the science is looking at”.

Treating infants with HIV soon after their birth is another work in progress. The Mississippi baby that was put on Anti Retro-Viral therapy (ART) 30 hours after birth, continued getting treatment for 18 months. After stopping the treatment there were no signs of HIV for 27 months, but the virus has been re-found in the baby at the age of 46 months. The cause of viral rebound after 27 months gap remains to be unexplained. That takes this prevention approach a step backward.

IMPAACT study P1115 is an important research step that would help us in understanding eradication of reservoir better, said Fauci. Prevention is treatment, prevention works. But prevention does not have to be uni-dimensional; it needs to be through a combination approach based on individual characteristics and risk factors, that works and has proved to be effective. 

Prevention of parent to child transmission is another success story on the prevention front. However, despite extraordinary progress made on this front, around 260,000 babies were born with HIV in 2012. That means that the challenge of babies born with HIV continues for scientists. PEPFAR funds and efforts did however at least ensure the birth of 1 million HIV negative babies born of HIV positive mothers.

HIV vaccinology is the other major area of research in progress. After 25 years of work and substantial amount of resources spent on it, the progress is still somewhat disappointing and limited. In contrast with classical vaccinology, HIV vaccinolgy is very different. HIV is a very different virus says Fauci and explains it further: The Neutralizing Antibodies in response to the infections form in a human body, but in the case of HIV this formation takes much more longer and the virus is never cleared. There is no protective immunity and the reservoir is literally developed within weeks of infection. After spending a lot of energy, time and funds on exploring for B cell vaccines, the focus of HIV science is now on developing T cell vaccines that would induce immune response, and on experimenting with Broadly Neutralizing anti HIV Antibodies.  

In case of  new HIV medicines while some progress has been made, challenges remain to be complex. The virus with its complex morphology and pathogenesis has put scientific expertise under a tough test.  The uture may be promising but extremely challenging, to say the least, and the solution may take more time.

As we move ahead in finding a cure and prevention of HIV, simplicity, scalability and sustainability of existing options must be ensured. After all, it is about millions of people living with HIV and about new infections occurring in a very inequitable world. After all, it is about ending this global epidemic.

Let us hope science can take humanity to an AIDS free generation, and bury the HIV virus in the pages of history.

Prakash Tyagi, Citizen News Service - CNS
24 July 2014 
(The author is a CNS Correspondent reporting onsite from AIDS 2014)

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