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Monday, July 23, 2012

More about: Towards an HIV cure


Discussions of an HIV cure were front and center at the first full day of the XIX International AIDS Conference in Washington, DC.

In his plenary session, Presidential Medal of Freedom recipient, Dr. Anthony Fauci, Director, US National Institutes of Allergy and Infectious Diseases said that the scientific basis does indeed exist for even considering such a thing as an HIV cure (1).

He outlined the chronology of advances in our understanding of HIV that could make this possible. He also interjected a note of caution - "No promises, no dates."

That said, he noted that advances in our understanding and treatment of HIV have been "spectacular." For starters, he noted that, “the advent of combination therapy makes it likely that if patients adhere to their regimen, they can expect a near normal lifespan.” He also cited the disappearance of mother-baby transmission as another major advance that links directly to the discussion of HIV treatment as prevention. Even in Washington DC a city with a high HIV prevalence, there has not been a case of mother-baby HIV transmission since 2009.

The “game changer,” he noted was HPTN 052, the multinational study that demonstrated a 96% reduction in transmission from an HIV-positive to a negative partner (1).

Are there challenges? Certainly, and HIV vaccine is one. However, he did note that even a less than perfect vaccine would be a major enhancement to our existing prevention activities. Equally elusive is a clearer understanding of naturally occurring neutralizing antibody that may hold the clue to a more successful, long-term management of HIV infection.

He also elaborated on the definitions of "HIV cure." For many years, he has made a distinction between "functional cure" and "sterilizing cure." Although sterilizing cure (purging the body of HIV) is still elusive, this remains an active area of investigation. Central to this hypothesis is our ability to destroy HIV infected cells once they migrate from sanctuary sites, he noted.

Functional cure is different. Certainly, today's combination antiretroviral therapy can drive viral load to very low levels for long periods of time - IF patients are adherent to their regimen. However, functional cure, he believes, is more complicated than just long term antiretroviral therapy.
He concluded that momentum is building for an HIV cure – either eradication or a “functional” cure. Successful implementation of these various approaches is possible, but that implementation will require a commitment from all stakeholders, at all levels, worldwide.

References:
1. http://pag.aids2012.org/session.aspx?s=723
2. http://www.nejm.org/doi/full/10.1056/NEJMoa1105243


Source: Reporting for the PRN News: Bill Valenti, MD