HIV positive no more a death sentence

HIV positive no more a death sentence

Advances in care over the last 30 years have helped transform HIV from a fatal disease into a chronic, manageable condition for many people. There is currently no cure but many clinical studies are dedicated to researching a cure. Where in one place research of antiretroviral therapy has proved as a milestone that has changed lives of millions providing them a normal life by maintain the virus at controlled levels. Progress in treatment has been transformative, but significant gaps in care still remain. 

Functional cure research

Progress towards creating a ‘functional cure’ focuses not on the elimination of HIV from the body, but rather on reducing the virus to a level that is undetectable; where the person no longer needs to take HIV-related medication, nor has any risk of progressing to AIDS or transmitting the virus. 

This can more precisely be described as a level of ‘remission’. Some advisory bodies have further suggested that this term be prioritised over calling it a ‘cure’, as suppressing viral replication still leaves traces of dormant HIV in the body which have the potential to re-emerge. Early antiretroviral treatment (ART), which is initiated close to the time-point of primary infection, certainly does not cure HIV, but there has been some success in individuals achieving temporary and long-term remission through this strategy. These people are called post-treatment controllers.  

In a 2012 study, 14 French people living with HIV known as the ‘Visconti cohort’, started taking ART within 10 weeks of infection. After three years of medication, they stopped taking treatment, which would normally result in HIV re-emerging.8 Remarkably, they maintained low levels of HIV in their systems for an average of seven years before a recurrence of the virus emerged.

The 2018 ‘Control of HIV After Antiretroviral Medication Pause’ (CHAMP) study yielded similar results – some 13% of those treated in early infection were considered post-treatment controller

Sterilizing cure research

Unlike a functional cure, a ‘sterilizing cure’ hopes to eradicate HIV from the body by measurably eliminating cells from latent reservoirs. This has proved a very difficult challenge for scientists, who believe it may be unattainable in most people living with HIV. 

The Berlin Patient

Timothy Brown – also known as the ‘Berlin Patient’ – is the only documented case of a person living with HIV to have been successfully ‘cured’. Through a combination of chemotherapy to destroy most of Brown’s HIV-infected immune cells and two bone marrow transplants to treat leukaemia, the treatment also seemed to have removed all traces of HIV in Brown’s body.

In selecting a stem cell donor, Brown’s doctors deliberately sought out someone with a rare HIV-resistant genetic mutation, whose CD4 cells had a resistance to the CCR5 co-receptor. The most common variety of HIV uses CCR5 as its ‘docking station’, attaching to it in order to enter and infect CD4 cells. Individuals with a specific mutation on the CCR5 (CCR5-delta32) are known to be naturally resistant to many HIV-1 strains because it renders deficient this co-receptor needed to inject HIV into the cell.

Brown continued to receive immunosuppressive treatment to prevent the rejection of these new stem cells for 38 months, after which his viral load tests confirmed that this treatment had effected a successful ‘sterilising cure’.

The procedure is considered very dangerous, and is unfeasible as an option for other people living with HIV. Several attempts to repeat this ‘cure’ in people with HIV who received bone marrow transplants have failed, and many of the cures currently being investigated are potentially toxic or risky, which could make clinical trials.

Although there are several approaches that could eventually bring a functional HIV cure, there are still some challenges ahead. One of the biggest concerns around any HIV treatments is the virus’ ability to quickly mutate and develop resistance, and for many of these new approaches there is still no data on whether the virus will be able to become resistant.

Extraordinary progress has been made in HIV since the epidemic emerged 37 years ago, but significant challenges still remain ahead of us. Gilead is strongly committed to driving the next generation of treatment, prevention, and cure strategy innovations that will continue changing the rajectory of the HIV epidemic by transforming care and improving overall outcomes for all people living with or at risk of HIV.