Reasons For Hope (RFH)
is Search For A Cure's national HIV treatment news series.
RFH covers the latest in developing therapies for treating HIV/AIDS.
RFH is published in over 90 community newspapers and found on many websites for people infected or affected by HIV/AIDS. We encourage your comments and critiques. Email hope@sfac.org Feel free to copy and distribute any and all RFH articles.
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Why We Should All be in a Clinical Trial
It is hard to get people to join a study of new medicines nowadays. This is mostly because people think the therapies we have are good enough. It's not true. HIV medicines fail some people. And they are too expensive for most of the world to use.
The medicines we have are not a cure, are a lifelong financial burden and have lots of side effects. The only way to see if new therapies work is to test them on people with HIV. The only way to see if a vaccine will work is to test it on people without HIV. If we want the day to come that HIV is a thing of the past the most important thing we can all do is find a study that needs us and join it.
Cure for HIV?
By David Scondras
hope@sfac.org
June 2007
Once again we are hearing about efforts to eradicate HIV, at least in some people. These efforts are being made, not by marginal actors, but by the country’s top doctors. On May 24th the Bloomberg report (Bloomberg.com) headlined the issue this way:
“Top U.S. Scientist to Use New AIDS Drugs Seeking Cure” (the scientist referred to is Anthony Fauci, longtime director of many HIV research efforts at the National Institutes of Health).
A summary of scientists’ efforts exploring the possibility of eradication can be found here:
So what happened?
Well, for many years it has been clear that after HIV gets into someone’s body, it starts infecting lots of cells. It inserts instructions on how to make HIV into the cells’ DNA. This turns the cell into a factory that can manufacture HIV.These instructions written into the cells’ operating instructions are called ‘provirus’.
Anyway, sometime after an HIV-positive person takes strong antiretrovirals, if you checked their cells, you’d see that although most of the virus has been eliminated from the bloodstream, there are still some cells that have these instructions on how to manufacture HIV, i.e. that harbor provirus.
Provirus does not make virus until the cell containing it is ‘activated’. Activated means a t cell is doing its job, manufacturing proteins, which happens when the cell recognizes a germ. For many t cells this does not happen for a long time. These cells that have provirus but are not producing HIV are called ‘latently infected’.No one knows exactly HOW long it takes before all latently infected cells are activated.
For this reason, most scientists, doctors and activists have been very skeptical about finding a cure for HIV. Finding a cure would require getting rid of all cells containing provirus. Unfortunately, the antivirals we currently use do not get rid of these latently infected cells.
Researchers have at least two different theories that might explain why HIV in someone’s body does not disappear altogether with the use of antivirals.
The first theory is that these latently infected cells which are not activated can hang around for as long as twenty or thirty or forty years. As soon as someone stops taking antiviral medicines, these cells can spring into action and manufacture HIV.
The second theory is that the medicines we have been using until now do not shut off all HIV reproduction, just most of it, and that is why when antivirals are stopped, the virus comes back.
This leads us to a hopeful possibility. What if we could eliminate virtually all infected cells with the help of newly available antiretrovirals? The immune system might be able to get rid of the few infected cells that are left. This is the operating theory behind radiation treatments for cancer.
How can we find out which theory is correct?
First we would use the powerful new antivirals now available which perhaps can shut down all HIV replication completely and then see if the body clears HIV infection.
Then, after testing to make sure no virus or provirus can be found, we would then stop using the powerful drugs and see if the virus comes back.
Sounds interesting, doesn’t it? This extraordinary experiment is actually taking place right now.
Why now?
First, because it has been discovered that in fact latently infected cells, containing provirus, DO get eliminated from the body. It is not clear why or how, but the data shows that the body does in fact get rid of these latently infected cells (provirus).
Dr. Fauci at the National Institutes of Health, whom I mentioned above, is conducting this study. His group found that in seven HIV-positive people who used strong antivirals early in their illness, there was a reduction in the amount of provirus by 50% every 4.6 months. If these results hold up, the scientists estimate that 7.7 years of the combination therapy could possibly eliminate HIV.
The second reason this study is being done now is because there are new powerful drugs such as entry inhibitors and others, which can be used to shut down viral replication, perhaps completely. Perhaps elimination of HIV would then happen faster, maybe in one year.
The experiment is underway. Patients will be dosed with the powerful new antivirals to hopefully shut down replication altogether for one year, and then they will be taken off the medication -- assuming no virus can be found -- to see if the virus comes back.
This is an experiment which needs to be done, and it’s fine to hope for good results. But there are good reasons to think it will not work, and we should not raise our expectations too high. Perhaps it will work in a few people but not everyone. Perhaps it will work for a limited period of time in some people, giving them a vacation from meds. Perhaps it will succeed completely and we can look forward to a cure.
The world will be waiting to hear the results.
David Scondras is the founder of Search For A Cure. He developed the nationally-recognized HIV treatment series, Reasons for Hope. All articles in the series are reviewed by expert HIV doctors & scientists as well as an HIV positive & negative focus group to ensure both accuracy and understandability.
This article has been reviewed by Alfred DeMaria, Jr., M.D.
Chief Medical Officer, State Epidemiologist
Director, Bureau of Communicable Disease Control
State Laboratory Institute and Dr. Cal Cohen of Community Research Intiative of New England.
Any errors are entirely those of Search For A Cure, not our reviewers.
If you have any questions or would like to receive the Reasons for Hope series contact Search For A Cure at 617-945-5350 or e-mail at hope@sfac.org . Please visit our web site at www.searchforacure.org
Search For a Cure is a not for profit organization providing education, promoting access & advocating the basic human right to safe and effective treatment for all people living with HIV/AIDS.
