george nisyrios | The dream of an HIV cure.
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Sep 22 2015

The dream of an HIV cure.

Most people with a bad medical problem want to be cured.  Take cancer as an example.  Of course this does happen for some lucky people.


But many medical problems are effectively treated and affected persons achieve a pretty good quality of life.


The drive behind finding a cure for HIV, is that without cure, treatment is lifelong, with associated toxicities and cost and the chance of passing on infection to others.


The last last few years has seen a renewed and more focussed interest in he field of cure for HIV.


Australia’s Professor Sharon Lewin of the Doherty Institute in Melbourne has become an international expert in the field.


In the early days of discovering effective antiretroviral medication, capable of preventing viral replication, it was thought that the outcome of successful treatment would be cure.


HIV infects a number of cells types within the body, and within these cells it can integrate into the DNA and remain there until that cell decides to turnover.  If the HIV is integrated into a cell that doesn’t go through its own life cycle for 20 years, the HIV can effectively stay asleep or dormant until that time point.


This is called latency.


So whilst effective medication can stop new viruses being developed and new cells being infected, current treatment cannot remove or deal with virus that is integrated in latently infected cells.  Therefore when treatment is stopped, after a period of time, virus returns in the blood  from virus released from this latent cell population.


Mathematical models have been developed to estimate how long an individual would need to be on totally effective treatment, whilst all latent cells release virus in the background, until such a point that no latent cells exist anymore – its a long time, more than a lifetime.  So treatment for 10-20 years is not enough.


The theory that drives research into HIV cure is the development of a drug, compound or method to stimulate latent cells to turnover and release HIV rather than harbour HIV.


If such a drug were discovered then perhaps an individual on successful treatment, could be given whatever drug over whatever time to stimulate all hiding latent HIV to be released, then be dealt with by the medication, so that when medication is ceased no more HIV remains.


Research is not that close right now to having a usable drug and some experts remain pessimistic about the future.


I think there should be optimism that a cure will be developed.


But as with developing an HIV vaccine, I think an understanding of how a persons own immune system could be stimulated to develop a durable and effective immune clearance of HIV will possibly be required as well as any therapy aimed at latency and the HIV itself.

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