Researchers and clinicians unite to answer what will it take to achieve an AIDS-free world?

November 06, 2013

November 5, 2013, San Francisco, CA--Since the onset of the AIDS pandemic more than three decades ago, researchers from the lab and physicians in the clinic have been working toward one shared goal: an AIDS-free world. This week, a conference hosted by the journals Cell and The Lancet brought leading researchers and clinicians together to discuss recent findings that could bring hope to the estimated 35 million people world-wide who live with HIV. Delegates from six continents converged on the meeting to bridge the gap between researchers and clinicians in a joint effort to identify what needs to be done before an AIDS-free world can go from dream to reality.

There are, to date, only a small handful of patients who have been successfully cured of HIV; Timothy Ray Brown, also known as the 'Berlin Patient,' was the first. Addressing delegates at the "Meeting the Speakers" dinner on Monday November 4, Timothy reflected on the trials, tribulations, and triumphs of his journey toward being cured of HIV. "I am the first person in the world to be cured of HIV, but I know in my heart I'm not the last," Timothy said. At the dinner, Timothy announced the Timothy Ray Brown Foundation's "Cure Coalition" and "Cure Report"--a new collaborative effort to bring various groups together in an effort to find and report on a scalable cure for HIV. "People around the world tell me my story is about hope," Timothy added. "This hope can translate to a cure."

Keynote speaker Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in the US, began the meeting by suggesting that, for a cure to work, it must be safe, simple, and scalable. Dr. Fauci discussed the feasibility of an AIDS-free world on the basis of scientific advances in preventing infections in those not infected and preventing illness in those who are infected. Preventive strategies include, among many others, the expansion of HIV testing, circumcision, treatment as prevention, and prevention of mother-to-child transmission. According to Dr. Fauci, "Biomedical interventions need to meld with human behavior and social determinants to achieve an AIDS-free world."

Before speakers examined the advances in these biomedical interventions, a number of researchers spoke of one of the largest roadblocks to a cure: the latent reservoir. The latent reservoir in HIV-infected patients consists of viral DNA that inserts itself into the genome of infected patients' cells, without replicating. Meeting co-organizer Dr. Robert Siliciano of Johns Hopkins University recently published a paper in Cell that found the size of the latent reservoir might be 60 times larger than previously thought. Warner Greene, director of virology and immunology research at the Gladstone Institutes, discussed studies that for the first time mechanistically link the two pathogenic signatures of HIV infection: CD4 T cell depletion and chronic inflammation.

"These discoveries could lead to three promising outcomes--an affordable bridge therapy for the 16 million who currently need but don't have access to antiretroviral therapies (ART), a potential solution for those on ART and who are developing aging-related diseases a decade or more before the non-HIV infected population, and a potential clearing of the latent reservoir that could contribute to a cure for HIV/AIDS," said Dr. Greene.

Perhaps the most widely discussed option for a cure has been the hope of a vaccine. A number of speakers discussed the various advances, and also setbacks, in the race toward successful vaccination strategies. Nobel Prize winner David Baltimore of the California Institute of Technology noted, "We need a vaccine, but we still don't have an open road in front of us." The key, according to Baltimore, is to not follow models of traditional vaccines but, rather, to "think about the extremely exciting observations that have been made about the kinds of antibodies that patients make in response to a long-term HIV infection." Speakers examined the various promising avenues toward developing an effective vaccine, including very recent work from Michel Nussenzweig and Dennis Burton on producing monoclonal broadly neutralizing antibodies in macaques.

Other researchers at the meeting examined how ART can be used for primary and secondary HIV prevention. Wafaa El-Sadr of Columbia University stressed the importance of developing roadmaps for scale-up of ART therapy in diverse settings. "Working diligently on developing and evaluating tailored roadmaps for expansion of ART is critical to achieving optimal outcomes for both PLWH and for prevention," said Dr. El Sadr. She emphasized the importance of recognizing the value of the science of implementation and of scale-up. Giving equal weight to implementation and scale-up alongside the science of discovery was another important point emphasized by the panelists in this discussion.

Many HIV patients have been living with the disease for decades, and as these patients age, they are faced with a new set of problems. Steven Deeks, of the University of California, San Francisco, explains that, for long-term HIV patients, "despite unquestioned success, the risk of developing many morbidities remains higher than expected." HIV patients have a 1.5- to 2-fold increased risk of developing these morbidities like cancer, cardiovascular disease, and liver disease, compared to the general population. Understanding the link between HIV, treatment, and aging will be needed to ensure healthy old age in ART-treated persons with HIV. Members of the audience who are living with HIV noted that mental health concerns should also be prioritized for research and support in the community.

The meeting concluded with a distinguished panel of researchers, clinicians, policy makers, and advocates broadly addressing the meeting's core question of what it will take to eliminate AIDS. Among the panelists was Nobel Laureate Françoise Barré-Sinoussi, who said, "I'm here as a witness of 30 years of HIV science and translational research." Steven Becker of the Bill and Melinda Gates Foundation noted that understanding the true cost of providing quality healthcare to all who need it is necessary. Separating costs and charges will be vital to do this. Dr. Barré-Sinoussi also stressed the necessity for collaboration if a cure is ever to be achieved "We need to continue the effort of working together if we want to make progress toward a cure."
-end-


Cell Press

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.