The biggest breakthrough in the fight against AIDS maybe coming soon as new research into cure strategies for HIV infection, generally considered unachievable just a few years ago, is now being seen possible.
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Official IAS Press Conference: Towards an HIV Cure. From left to right: Sharon Lewin, Lynda Dee, Christopher Peterson, Asier Saez-Cirion, Steven Deeks, John Mascola and Francoise Barre-Sinoussi. Photo ©Steve Forrest/Workers' Photos/IAS[/caption]
Scientists at the 8th the International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015) in Vancouver noted that similar scientific pathways may result in both a vaccine and a way to achieve long-term remission of HIV as a number of studies have begun to produce mutually reinforcing discoveries.
“Increasingly sophisticated insights into the virus, its progression and the body’s response to HIV are helping to narrow and concentrate the focus of the HIV cure research agenda,” said Nobel Laureate and former IAS President Françoise Barré-Sinoussi of the Pasteur Institute. “Today, we now know to focus our efforts on developing better tools to measure HIV infection, boosting immune responses to HIV and understanding what individual cases of HIV remission can teach us about more broadly applicable strategies for the long-term control of HIV infection.”
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The three-decade-long fight against AIDS has seen a series of breakthroughs in recent weeks, showing momentum in the push for an HIV cure.
On Tuesday, at IAS 2015, researchers detailed some dramatic findings which confirmed that, for people with HIV, starting treatments with antiretroviral drugs early did prevent AIDS-related illness and deaths. For all these years, there had been concern that starting such therapy too early might increase patients’ risk of cardiovascular and renal disease.
The exciting news comes on the back of another groundbreaking development from France, when an 18-year-old teenager born with the AIDS virus has had her infection under control and nearly undetectable despite stopping treatment 12 years ago — an unprecedented remission.
The teen might have some form of natural resistance to HIV that hasn't yet been discovered. But her case revives hope that early, aggressive treatment can limit how strongly the virus takes hold, and perhaps in rare cases, let people control it without lifelong drugs.
A few years ago, doctors reported a similar case: a Mississippi girl who kept HIV in check for 27 months without treatment. But then her virus rebounded, dashing hopes that early treatment might have cured her.
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At least a dozen adults have had remissions for a median of 10 years after stopping HIV medicines, but the new French case is said to be the first long-lasting one that started in childhood.
The case was described Monday at an International AIDS Society conference in Vancouver, British Columbia, by Dr. Asier Saez-Cirion of the Pasteur Institute in Paris. The teen lives in the Paris area and her identity was not revealed.
"This is an exciting story," but it is unknown if the remission will last, said Francoise Barre-Sinoussi, a scientist at the Pasteur Institute and a co-discoverer of HIV.
"This case is clearly additional evidence of the powerful benefit of starting treatment as soon as possible," she said.
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Most HIV-infected moms in the U.S. get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. The French teen's mother did not have her HIV under control in pregnancy, and doctors think her daughter was infected before or during birth.
Doctors gave the baby an HIV drug — zidovudine, or AZT — for six weeks, which was the standard of care at that time. Tests then showed she still had high levels of HIV in her blood, so she was given a more powerful four-drug combination.
She stayed on treatment until she was nearly 6, then doctors lost contact with her. When she came back a year later, her mother said she had stopped giving the girl HIV drugs. Yet doctors could not find HIV in her blood so they decided not to resume treatment.
Except for one brief rise when she was 11 that resolved on its own, her virus has remained below a detection threshold ever since, although doctors can still find some at extremely low levels when they look with very sensitive tests.
"This girl is in remission of infection but she is infected" and not cured, Saez-Cirion said. She doesn't have any of the gene variants or other biomarkers that are known to give natural control or protection from HIVinfection, and she was not able to suppress the virus on her own before getting the powerful drug combo. Those things suggest that early treatment is responsible for the remission, he said.
Sharon Lewin, an AIDS scientist at the University of Melbourne in Australia, said "it's always hard to know, when you have a single case report, is there something about this particular individual that's unique? What's in the back of people's minds is, would this have happened anyway," independent of her treatment, she said.
Dr. Steven Deeks, an AIDS specialist at the University of California, San Francisco, agreed, but said the case "adds to the growing story that we should be treating everybody really early."
That goes for adults, too. A big study recently was stopped early because the benefits of starting treatment as soon as possible after diagnosis were clear. Details of that study also were presented at the AIDS conference on Monday.
First-time findings on the potential role of gene therapy in the search for a cure
Little has been known about whether the approach of gene editing in stem cells would be feasible in large animal models. Christopher Peterson of the Fred Hutchinson Cancer Research Center explained how he and his team deployed Zinc Finger Nuclease genome editing techniques to edit the CCR5 “Trojan horse” receptor that HIV uses to infect the immune system’s vital CD4 cells. The ground-breaking study is the first successful long-term multilineage engraftment of Zinc Finger Nuclease-edited, CCR5-deleted hematopoietic stem cells in a non-human primate transplantation model. This model enables the evaluation of novel therapeutic approaches not only in the context of acute HIV exposure, but also in the clinically relevant setting of pre-existing latent HIV infection.
Promise of broadly neutralizing antibodies in developing both a vaccine and a cure for HIV
John Mascola of the U.S. National Institutes of Health provided an overview of his latest research on broadly neutralizing antibodies. In his study, the HIV-1 monoclonal antibody was administered to eight HIV-1 infected subjects with detectable plasma viremia, and plasma viral load was followed for 90 days. After a single antibody infusion, plasma viral load decreased by approximately 10 to 50 fold in six of eight subjects, with maximal effects seen between one and two weeks after infusion. The two subjects with minimal response to the antibody infusion had circulating virus that was resistant to the VRC01 antibody. This study provides evidence that an HIV-1 neutralizing antibody can lower plasma viremia and that the effect may be associated with pre-existing viral sensitivity to the antibody.
The conference in Vancouver, considered the leading scientific meeting on HIV, is organised by the International AIDS Society (IAS) - the world’s largest association of HIV professionals, with members from more than 180 countries – and brings together a broad cross section of more than 6,000 HIV professionals from around the world, with a focus on moving science into practice.
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(With agency inputs)