Scientific Research for an AIDS ‘cure’ and HIV Prevention and Treatment for Key Populations

Ishdeep Kohli - CNS
In the race for a cure for HIV, we have the Berlin Patient, the Mississippi Baby, the Visconti Cohort - 14 patients in France - and most recently, two men in Boston who were declared to be HIV- free. Through a variety of mechanisms and treatments including bone marrow stem-cell transplants and gene therapy, all of these people were able to shake the virus and stop taking the drugs that HIV-infected patients ordinarily need to survive. They represent possibility - that modern science is capable of curing a deadly infection.

Speaking at the Media Conference at ICAAP, Professor Sharon Lewin discussed the ongoing trial in Melbourne involving HIV-positive patients who are testing the ability of a drug to ‘wake up’ the virus in cells where it lies dormant and hidden from the effects of current antiretroviral drugs. The research at The Alfred Hospital, Monash University and Burnet Institute is part of a global effort to find a cure for the virus. This particular approach to a cure, one of a handful worldwide, is based around the way the HIV virus behaves. Professor Lewin said the impetus to find a cure lay in the huge economic cost of keeping infected people on antiretroviral drugs for life. "There is a lot of excitement among patients, but we don't want to raise expectations too high.,” said Prof. Lewin, Director of the Infectious Diseases Unit at The Alfred Hospital; Professor of Medicine, Department of Medicine, Monash University; Co-Head of the Centre for Biomedical Research, Burnet Institute, Melbourne, Australia and Local co-chair, XXth International AIDS Conference (IAC), Melbourne Australia. She added that although the cases created hope that a cure was possible, more patients needed to be studied in similar circumstances to see if the mechanisms could be understood and assist ongoing research into a more universal and practical cure.

Ten years ago, we would not have been able to speak about a cure in realistic terms; today, things are different. While there are still complications, research has brought us to a point where ARV therapy can remove HIV from a baby’s body to non-detectable levels and some adults are able to stop treatment without negative health effects. An end to HIV is close, but we’re not there – not yet. Prof Lewin highlighted that ‘Stepping up the Pace’ has been selected as the theme for AIDS 2014, the upcoming 20th International AIDS Conference, Melbourne, 20 – 25 July 2014.“Stepping up the Pace recognizes that we are at a critical time in the global response to HIV and the role of communities is critical”. Rico Gustav, Asia Pacific Network of People Living with HIV/AIDS raised his concerns about the pressure mounting on India to sign off on the free trade agreement which contains provisions that will harm people’s access to medicines in India and across the developing world. With India already obliged under international trade rules to start granting patents on newer medicines – including newer medicines for HIV, cancer and hepatitis C – production and access to affordable medicines is already becoming harder.

Dr Gottfried Hirnschall, Director of the HIV Department of the World Health Organization, stressed, “Countries need to move to earlier treatment, better treatment and simple treatment”. He raised his concerns about alarming micro epidemics in the region especially among key population groups, “We need to focus our energies on key populations - on injecting drug users, men who have sex with men, commercial sex workers, prison populations and so on. So far there has been insufficient focus on these groups, access to testing is low and late initiation of treatment”.

Dr Chris Beyrer President-Elect of the International AIDS Society and Professor of Epidemiology and International Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, spoke about the critical importance of key populations and ongoing challenges of providing basic prevention and treatment options. Particular concerning is the data on young men who have sex with men showing high incidence of HIV infection. Responding to the epidemic of HIV among young gay and other MSM including female Transgender populations He said, “Expand the repertoire of prevention tools, in addition to expanding testing and treatment of HIV-positive men, stepping up risk prevention of HIV-negative men through the use of Pre-exposure Prophylaxis (PrEP), and increased access to and coverage for condoms. This requires leadership, vision and new science including stepping up pace of implementation”.

Ishdeep Kohli, Citizen News Service - CNS
November 2013

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.