Lessons learned from the failure of strategies to purge the HIV reservoir and cure HIV infection open the door to test radically different approaches.
Online PR News – 04-July-2014 – With the advent of combined anti-retroviral therapy HIV infection has become a chronic disease. However, if AIDS is no longer the penalty in correctly treated patients, the number of HIV-infected people increases regularly due to the decrease in mortality and the fact that the pandemic is not yet under control. Life-long anti-retroviral therapy brings the issue of cost in the context of a financial crisis with most patients living in poor-resources countries.
It is therefore mandatory to discover a HIV cure in order to stop anti-retrovirals in these patients.
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In 2007, the report of the Berlin patient who was apparently cured from HIV has spurred the global interest for gene therapy in order to eradicate HIV. However, this case was not reproduced and the use of Zinc Finger Nucleases failed to get rid of HIV.
Anecdotal cases of HIV remission have been reported after initiating anti-retroviral therapy very early at the time of acute infection. However, this functional cure concerns a minority of patients and diagnosis of HIV at the acute phase needs strong surveillance of populations that is difficult to implement.
In the past 5 years, cure research concentrated on strategies to activate dormant proviruses in order to deplete the reservoirs. A wide range of potent HIV activators has been selected in the laboratory and a couple of them, like vorinostat, panobinostat and disulfiram, reached clinical trials. Unfortunately results showed that they were not potent enough to reactivate all latent proviruses and, furthermore, cells with reactivated HIV were not eliminated by Cytotoxic T Lymphocytes (CTL), which are deficient in patients.
Consequently, new approaches towards HIV cure have to be tested.
In the past, old world primates were infected by ancestral retroviruses which are now included in the human genome and remain silent. According to Doctor Alain Lafeuillade from France, the same could be obtained in HIV-infected patients by using drugs able to sabotage the natural history of HIV. In perspective is the use for a defined period of time of Dolutegravir, a new integrase inhibitor, as monotherapy in patients nave of therapy. When this drug selects viral resistance (and monotherapy is the ideal situation for this) it is associated with a dramatic decrease in viral fitness, meaning that we have got a crippled HIV.
About the Community of Researchers for HIV Cure: it is a group of basic and clinical scientists involved in the study of HIV persistence and the set up of new therapies.
“We are launching clinical trials testing revolutionnary approaches to cure HIV.”