“How come we have been able to fit everything that life needs into one mobile phone device we can keep in our pockets, but cannot find the cure for HIV?” This was a question a young man asked Dr Francoise Barre-Sinnousi, the International AIDS Society chief executive, in a discussion at the AIDS 2014 conference in Melbourne, Australia.
The prevention and cure of HIV remains one of the most sought after medical research issues of all time. Significant advances have been made but the goal of preventing or curing HIV still seems to remain out of reach.
Anthony Fauci, of the US National Institute of Allergy and Infectious Diseases, explained the research progress at AIDS 2014 in Melbourne. “Eradicating the HIV reservoirs in the human body and HIV vaccinology are two broad platforms that the science is looking at,” he said.
Preventing HIV in babies
Treating infants with HIV soon after their birth is work in progress. In one well-known case, a baby from Mississippi was put on antiretrovirals 30 hours after birth and continued receiving treatment for 18 months. After stopping the treatment, and with no signs of HIV for 27 months, the virus was re-found in the baby at the age of 46 months. The cause remains unexplained and takes this prevention approach a step backwards.
“IMPAACT study P1115 [which looks at very early intensive treatment of infants to achieve HIV remission] is an important research step that would help us in understanding eradication of reservoir better,” says Fauci.
“Prevention is treatment, prevention works. But prevention does not have to be one-dimensional. It needs to be through a combination approach, based on individual characteristics and risk factors. This works and has proved to be effective.”
Prevention of mother to child transmission is another success story. However, despite extraordinary progress made on this front, around 260,000 babies were born with HIV in 2012. That means the challenge of babies born with HIV continues for scientists. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funds and efforts have however ensured the birth of a million HIV-free babies from HIV positive mothers.
Search for vaccine
HIV vaccinology is the other major area of research in progress. After twenty-five years of work and substantial amount of resources spent on it, the progress is still disappointing and limited. HIV vaccinology is very different from classical vaccinology, as HIV is a very different virus, according to Fauci.
“Antibodies which neutralise a virus form in response to infections in a human body. But in the case of HIV, this formation takes much longer and the virus is never cleared. There is no protective immunity and a ‘viral reservoir’ develops within weeks of HIV infection.
“After spending energy, time and funds on exploring for B-cell vaccines, the focus of HIV science is now on developing T-cell vaccines that induce an immune response and on experimenting with ‘broadly neutralising anti-HIV antibodies’.”
Complex challenges
According to Fauci, some progress has been made, but complex challenges remain in HIV medicine. The virus is a tough test for scientific expertise and future solutions will take more time.
As scientists move ahead in finding a cure and prevention of HIV, simplicity, scalability and sustainability of options must be ensured. After all, millions of people are living with the virus and new infections continue to occur in a very inequitable world.
However, there is still reason to hope that science can help take humanity to an AIDS-free generation and consign HIV to history.
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