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Progress and Controversies in Cure Research

I just returned from one of the most fascinating and promising conferences on HIV cure research that I've ever attended. Held November 28 to 30 in Washington, D.C., the Division of AIDS from the National Institutes of Health (NIH) sponsored a meeting that brought together many of the researchers funded by or collaborating with the Martin Delaney cure research collaboratories.

Martin Delaney, Marty to me, was a mentor and close friend and founded the advocacy group Project Inform in 1985. One of the giants of AIDS treatment advocacy, it is fitting that the research collaboratories--public private partnership to move cure research as rapidly as possible from the test tube to the bedside--bear his name and I am certain he would have been as thrilled as I was with the quality of the science presented and discussed at the meeting.


Though the meeting, as any government-funded meeting, was technically open to the public, some of the data presented has not yet been presented formally at conferences or published in journals. For this reason, we were asked not reveal all of what we learned over the course of the meeting just yet, at least not in detail, but I can say that evidence of progress was certainly evident and is likely to be reported in fuller detail soon.

I expect that much of what I learned will be presented in the coming months at the Conference on Retroviruses and Opportunistic Infections (CROI) taking place in March in Atlanta, or the International AIDS Society (IAS) meeting to be held in July in Malaysia, or at another upcoming meeting.
Roughly speaking, however, we learned of both adults and children who appear to have gained extraordinary control over the virus due to very early antiretroviral  (ARV) therapy, we're talking about people who started within days or weeks and not months or years.

One of the cohorts described, from France, has been previously presented, but further details were fleshed out at the meeting. Though it is rare that people rush to get tested immediately following an initial exposure to HIV, some do. In France, about 200 people have been located in the French health care system who initiated treatment during acute infection, which is typically defined as the period between initial exposure and the development of antibodies against the virus, usually a matter of weeks. After a number of years on treatment, some of these individuals treated during acute infection decided to try going without ARVs, and thus far about 11 of them have been able to remain off treatment for several years with only very low levels of detectable virus. In essence, they look just like people on effective ARV therapy except that they are no longer taking any of the drugs.

Are they cured? No, not in the traditional sense, nor do we know how long they will continue to control the virus on their own. Even elite controllers, people who nature blessed with the right genes to keep HIV under control naturally, sometimes do see virus creep back and CD4 cells fall. Nevertheless, French researchers estimate that perhaps as many as 10 percent of people who start treatment this early may later be able to go without it for long periods of time. This is a small step down the road toward a cure, at least a "functional" cure, but still important.

We also learned of progress in cure research in HIV-infected children. Unfortunately, I can't report in more detail than that, but I encourage you to look in the coming months for an exciting announcement to come from pediatric HIV researchers.

Things are also looking promising for people with HIV who are also diagnosed with chemotherapy-resistant cancer. Though stem-cell replacement carries serious health risks, and though many people with HIV and malignancy eventually relapse and succumb to the cancer, there is tantalizing data suggesting that a variety of stem cell strategies could indeed result in a cure in these people in the not too distant future.


Thankfully we have now progressed from asking whether a cure will ever be found to just how long it will be until a cure might be realized in such a way that it will be available to a large number of people with HIV.

Unanswered questions and controversies remain. Among the most important is how to determine where the virus is and whether a given therapy causes latent forms of HIV to awaken or to be eliminated. One of the key challenges is the fact that in many people on ARV therapy, latent virus is present in only one in every million cells. This not only requires that people give up lots of blood to find the virus, but that extremely sensitive tests be used to detect it.

Right now the gold standard is incredibly expensive and laborious. First researchers find infected cells and then they prompt those cells to reproduce HIV. Only those cells that produce versions of the virus that is capable of reproducing and infecting other cells are counted as being productively infected. Unfortunately, very few labs are capable of running such a test and if we are to test cure strategies more widely they will require a test that is much less expensive and much easier to run with a lot less blood or tissue being taken. Researchers are working on this, but it will likely be at least two or three years before we are able to begin to validate these easier tests. In the meantime, we will do our best to determine which kinds of therapies are able to wake up silent sleeping HIV--something we need to do in order to exterminate the virus and the cells that carry it.

Another important controversy is where HIV lives in the bodies of HIV-positive people. Some think it is really only necessary to get therapies into CD4 cells of the lymph nodes and lymph-like tissue in order to eradicate HIV. Others believe that other cells types such as macrophages in lymph tissue and in the brain will need to be reached as well. As with cell-based tests, it's going to take a bit of time to figure this out.

Lastly, in order for "shock and kill" strategies to work--whereby treatments are used to flush out sleeping HIV and kill it--we will have to ensure that current ARV therapy is good enough to stop all virus from reproducing. Unfortunately, recent studies have indicated that current therapy, while amazingly effective, doesn't reach all cells equally. In fact, some of the most potent drugs may not make it into the lymph nodes (where most HIV lives) at all. Whether this is true or important will take further research, much of which is underway.

What's the bottom line?

In all, cure research is probably going to proceed much as most other research, including early ARV research and cancer chemotherapy. At first, we will probably be able to cure a small number of people for reasons we don't entirely understand. Those early experiments will be a vital step along the path to a wider cure strategy, but won't take us all the way.  There's much still to learn, but it I believe it is incredibly encouraging that we have moved so quickly from disbelieving in a cure and having no dedicated money for it, to a wide scope of researchers determined to further cure research with millions of dollars dedicated to the effort.

Are we doing enough quickly enough? That is an arguable point and one that activists, including myself and others at Project Inform and elsewhere will have to content with. In the meantime, I can genuinely say that progress is being made and that the day when cure patient #2 or #3 is announced is likely going to be announced within years and not decades.


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Comments on David Evans's blog entry "Progress and Controversies in Cure Research"

Good news
I always believe that once we have the 3rd "Berlin Patient" then HIV WILL BE CURABLE

Personally I am hopful for the cord blood tests in Holland and the Vac4/5 tests in Norway.
Any news on these at the meeting.

I can see an end to daily drugs soon either replaced by a weekly dose (although adherence would be a problem) or once monthly/bi-annual/annual injections

I firmly believe in cure after all these efforts the researchers have ginve. Not in deacades but years is a good news.

It all obviously depends on your differentiation of "cure".

As I mentioned above I do believe in the end of drugs to be replaced by injections
At first these maybe one a month but in time (as ARVS progressed)you may only need an injection once a year
I have even heard of some tests on therapeutic vaccines that suggested only needing one injection every 5 years although I feel this unlikely.

Some one is either cured or not cured IMHO so all these people in France or the BMT patients in the US get them off drugs and see if they can control the virus if they can as far as I am concerned they are cured

I sincerely hope a 'cure' is found soon, but more important for me is a vaccine. My partner is negative and although we are pretty safe about it, and I'm undetectable--it still scares me that I could pass on this disease to him. Keep it up researchers, we need you!

I sincerely appreciate the sense of hope and optimism in this article, but I sadly believe there will never be a cure for AIDS or any other disease, for that matter. There is no profit margin in cures. We live in a culture ruled by profits and the healthcare industrial complex will never allow cures. Why would they cure a disease and give up a lifetime customer for their pharmaceuticals, testing equipment, salaries, etc. If a cure does come, it will never come through the United States. PHARMA, the AMA, the AHA, and all the other lobbies that need sick and dying people to support their way of life will never stand for it. It's naive to think that the medical establishment would forfeit their trillion dollar profits. THE BIG BUCKS ARE IN CHRONIC DISEASE!!

Ha ha ha ha, in the 70's, 80's, early 90's, MAYBE. But your conspiracy theories are laughable now. 1) there IS profit margin in any new cure, and if Tom won't take it Harry will, 2) We live in an age that is too global and connected to allow for something as big as a wide, affordable HIV cure to be 'suppressed' by corporations. There are simply too many people working on too many of the same things, and watching the end result of each other's work to allow for any rug-sweeping. The human spirit is inherently altruistic so, sorry - except for the comment that a cure will not come from the USA, I profoundly disagree. As I'm sure do millions.

In relation to post I posted a link to preventative vaccine trials but it doesnt seem to have been published

Basically they doing further tests with the Thai Vaccine and seem very confident with the whole thing
They hope to achieve a 50% efficiency which is what they need to start licencing this out
Small tests are taking place in Thailand among MSM and large scale Phase 3 tests in South Africa

Link here to audio

50% may not sound like alot but if you could reduce global diagnoses of HIV by 50% that would be huge

Its great to know of all the advances human kind is doing combating HIV.I beleive that one of the most important things pharmaceutical companies should be focusing in is finding antiretroviral medicines (ARVS) with less side effects. Of course its fundamental to find the total cure, but while that happens the meds available now should be improved to lower side effects.One of the problems me and many other people HIV positive, is trying to find the right meds that dont throw us off board because of side effects and thus reach a complete adherence to therapy.So to sum up my comment: PLEASE FIND ARVS WITH LESS SIDE EFFECTS. Thanks.

I first tested positive in 1986. My first t-cell count was done in 1989 and was 1287. I monitored my status for many years, through studies,both at ucsf, and nih. I remained with a viral load of between 8,000 and 30,000 until 2003 when i first began antiviral treatment. Today, i remain undectable with over 600 there are many ways to approach this virus.

Is HIV curable? That's the wrong question, and it betrays a disheartening bias. It's already been cured. This isn't science fiction, it's science fact. HIV has probably been cured a few times. Will any of us ever be cured? At the rate we're moving, that's unlikely. What we need is a little less optimism that "it will happen", and a lot more insistence that it's made made workable for all of us.

you are very wrong. The US goverment will save $20 billion per year if the cure is discovered. The cure will not be discoverd by pharmaceutical companies rather by scientists in NIH and at least one hundred medical centers in US. The US govermnet can dictate to pharmnaceutical companies to manufacture the discoveries found by scientific communities. Do not be simple- minded

A cure is coming we just need to make sure they will give it to us when it is here
News released today of an Therapeutic vaccine which has shown to reduce VL by 90%

They state in the article :
"Unfortunately, the efficacy of the vaccine was only temporary. After a year, patients needed to start antiretroviral therapy once more."

I would consider only needing an injection once a year a mark improvement on taking pills everyday.

We need to get these things of of the lab and into the clinics as quickly as possible.
It shouldnt be difficult to test this stuff out in large scales in Europe
Pick a country like Slovakia and give it to ALL HIV patients in that country and then see where they are in after a year.


Are they cured? No, not in the traditional sense, nor do we know how long they will continue to control the virus on their own. Even elite controllers, people who nature blessed with the right genes to keep HIV under control naturally, sometimes do see virus creep back and CD4 cells fall. Nevertheless, French researchers estimate that perhaps as many as 10 percent of people who start treatment this early may later be able to go without it for long periods of time. This is a small step down the road toward a cure, at least a "functional" cure, but still important.

The above is a problematic paragraph - I am an elite controller, so I have been told - my blood was sent to California for an expensive assay that measures the # of copies below 50 - they couldn't find a single viable copy of HIV in my blood - I have been on the cocktail since 1996 - the cocktail saved my life because I am not a long term non-progressor and was sick all of the time with various AIDS defining illnesses until the cocktail kicked in - today I have 1,460 T cells, undetectable VL and CD4/CD8s around 40% - we already know that about 12% of HIV infected persons will not get sick (because they are long term non-progressors) which makes the comments of the French researchers moot. You should have seen my previous doctor nearly fall off his chair laughing at me during our first visit when he asked me 'what brought you here?' - I said 'I want 1,400 T cells (they were around 600 at the time of my first visit with him)' - he literally laughed out loud at me and said,verbatim, 'dream on girl!' (He's a gay doctor) - so whose laughing now?

While finding a cure for HIV/AIDS maybe difficult proving if something works or not shouldn't be.

Take the case over the last two week in Nigeria
Doctor claims to have herbal cure for HIV. Says woman who tested positive on ellsa test now negative.
Was he just lying. Did anyone find this woman
Its not hard to retest someone.
Give someone the drug and see if they are "cured" if their VL drops.
There are people all over the world dying who have no access to treatment at all
Test some of these drugs on them.

Do not dismiss treatment out of hand because it comes from Africa or sounds too good to be true. Most medical advances in life have been found by accident or as a result of some one taking a chance on something.

They seem much more open to risks and trying stuff out in cancer research than with HIV

A great article filled with progress and hope. If we settle with "decades rather than years" for a cure, we will lose hope, our loved ones, and possibly a generation once again. The economic impact of a cure far out weighs current profit. Healthy people could reenter the work force, adopt or raise their own children and give back to the community.

Why can't they just inject ARV's directly into the lymph nodes? Surely if it's directed into enough lymph nodes the remaining nodes will get a dose of the ARV too?

In my opinion a cure is having monthly injections and not having inflammation and having to suffer the natural effects of HIV infection. So basically you are HIV+ but a) non infectious and b) will not be more susceptible to non-HIV related illness. Now that's a real cure! Anything else from the patients point of view is just media hype.

All this talk of flushing out the HIV cells and chemotherapy, but at what cost, a depleted immune system? Death?

Just give people a sensible fuctional cure so that they can live a normal life.

I agree blueballs :)
and even if the first injections are once a month I believe this could decrease in time to once every 6 months or once a year

I believe we are very close to this IF there is will amoung medical bodies and the general AIDS NGOs

For those who think 1000+ scientists (that work with HIV) are keeping their overly opinionated mouths shut about an HIV cure, should just stop commenting on HIV related articles. Its so easy to point fingers with your conspiracy leaders that sell CURES THEY DON'T WANT YOU TO KNOW ABOUT books and how-to's that make them rich (while they're laughing at you for following them). Or protesting along side them as they make YouTube videos go viral depicting false cures using bark and vinegar that only make you have diarrhea. Denial is a stage in the healing process that we all have to deal with. So DEAL WITH IT. The government isn't mutating viruses so we have to get flu shots every year, there is no "hidden" cures, and all those scientists and inventors that you read about that "died of unknown causes" (aka, government killed them) are A (still alive) B (were fired or jailed because they were idiots) or C (they might have really died because we all die from something). I repeat, anyone can create videos, articles, research papers, patents, etc. That doesn't EVER make them true, working, important, or even reliable. DO NOT BELIEVE ANYTHING YOU READ, LISTEN TO, OR SEE ON THE INTERNET.

Gilead did a crap job about "hiding/covering up" their intentions on NOT joining with Bristol in the HEP C cure... Its all over the news (but lets not report this, conspiracy theorists).

so we found out that bee venom kills the HIV in all strains. when are we going to work that method into the cure? producing a wake to wake up the HIV cells with Zolinza medication that awakens cells and injection a serum of bee venom guided with other medication to seek out and destroy the active cells?

I pray everyday if not minute of my life that the scientist(God bless them) find a cure I believe its a matter of years (4) or less until they find a cure. Im in south Africa and im so grateful to the people that are involved in making treatment possible and in search of a cure. everything is possible we need to have faith in God

I have been married to my wife for 14 years and she has been on ARV's since our marriage. In the beginning before we discovered that she was HIV we had sex for nearly a year. I have only once gone for a test and I was negative. My wife is still on ARV treatment but is living a normal healthy lifestyle. However I had sex again wife my a few years ago and I have not seen any changes in my weight or my wellbeing. She suggested to me to go for a test again but I did not go. It might sound strange but I do believe that I am immune to the disease. Can you please give me some insight to this belief that I have and is it true that some people is immune to HIV.

heartening news

I am curious, arent the drug companies lining there pockets with all the drugs Hiv carriers have to buy and actually taking their time to find a cure, why have they not made Hiv meds into injectable form yet? The drugs are so strong its causing patients stomach linings to burn and making them more vulnerable to illness, is injectable Arv's not the way or is it going to take revenue out of the tablet manufacturers pockets ? Do these companies realise there are innocent people that got the virus through being violated by vagrants who do not care about others or themselfs? If they could find a cure for a flue strand that keeps evolving why are they not doing it for HIV that stays the same??? So many questions ? Only one answer money is more importsnt than people and the world is over populated as is, Im sure that is what the fat cat in there castles are saying to each other???? Untill they get HIV ... Oh sorry they can actually pay for a cure !!! Yes im frustrated and angry, wouldnt you be?

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About this Entry

This page contains a single entry by David Evans published on December 12, 2012 8:32 AM.

AIDS 2012: Did It Matter That 23,767 People Came to D.C. to Talk About AIDS? was the previous entry in this blog.

Valentine's Kiss from the Government's HIV Treatment Guidelines Committee is the next entry in this blog.

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