“The Challenge of a Cure for HIV Infection,” published in the March 6, 2009 issue of the journal Science, calls for a coordinated initiative involving academia, industry, patient advocates and government to accelerate the search for a cure.
“HIV infection remains a big domestic and international health problem despite the development of effective antiviral therapy, which is now becoming available across the world. But we must ask the question, is this really the best we can do? And is there a way we can eradicate the infection from people?” said Dr. David M. Margolis, a paper co-author and professor of medicine and microbiology and immunology in the University of North Carolina at Chapel Hill School of Medicine. He is also a professor of epidemiology in the UNC Gillings School of Global Public Health.
While the current approach to treating the disease, known as highly active antiretroviral therapy or HAART, has allowed many patients to assume a relatively healthy life unencumbered by symptoms or side effects, the authors point out it is no panacea.
Margolis and his colleagues acknowledge that the HAART approach of chronic suppression of HIV replication represents a triumph for modern medicine, but add that its success is limited by its cost, the requirement of lifelong adherence (HIV virus levels can rebound rapidly if treatment is interrupted) and the unknown effects of such long-term treatment.
The goal of HIV therapies, the authors propose, should be a drug-free remission. This goal requires a better understanding of the persistence of HIV infection or the presence of low levels of the virus in the bloodstream. Persistent infection is maintained in reservoirs like latently infected white blood cells or scavenger cells of the immune system. There may be other, as yet unrecognized, reservoirs as well, they said.
HAART is now being used by more than 4 million people around the world to keep the latent HIV virus in check, said lead author Dr. Douglas Richman, professor of pathology and medicine at the University of California San Diego and director of its Center for AIDS Research. “Without a vaccine, we are left with the substantial financial burden of lifelong treatment for tens of millions of people. Acknowledging and addressing the challenges outlined in this paper is the first step toward progress.”
“Purging latent HIV infection may be a distant goal, but if we can achieve it, it would completely change the equation,” Margolis said. “People would not avoid the diagnosis because therapy would not be life-long and they might not be stigmatized with HIV.”
Along with Margolis and Richman, other authors of the paper are Dr. Warner C. Greene of the Gladstone Institute of Virology and Immunology and the University of California San Francisco; Dr. Daria Hazuda of Merck and Co.; Dr. Roger Pomerantz of Tibotec Pharmaceuticals Inc. and Johnson & Johnson Corp.; and the late Martin Delaney of “Project Inform.”