The search for immune based treatment such as a vaccine continues. And the pace is frustrating both for those HIV negative and those who are infected looking for a vaccine to boost immunity. Nonetheless the search continues - and your question has a few raised a few issues - but, first - what about eradication?
Well, sadly, it is increasingly clear that eradication as we understand it is an elusive goal. Getting this virus out of every cell in which it hides just seems very hard to do with current treatment. Since it hides in some of our longest lived cells. Cells that are programmed to live as long as we do. And it is hard so far to develop tools or treatments designed to specifically knock all of these out. And, since HIV hides in probably every organ in the body, this goal of eradication just seems out of reach at the current time. Not off the radar - just beyond our current technology. So what of second best - stalemate?
Well, we have written of this here before and there is not much more news in the past few months. In sum, we do have evidence that we can control HIV without taking medication every day every day every day, and with this type of control, look towards a normal life span. Certainly at least a life without AIDS. In fact, the current discussions of the moment focus on strategies to increase the chance that people can take meds as needed, and have all the plusses of meds, while minimizing the downside of meds. These downsides include the side effects of them, as well as the challenge of remembering to take meds every day. One of the breakthroughs in this field are coming from the NIH, where a small study led by Dr. Dybul has so far shown that people whose viral load is already suppressed below 50 copies for months can then take breaks off meds for up to 7 days and still not develop viral rebound over 50 copies. This study has led to some considerable controvery but additional exploration of the strategies allowing us to maintain control with something a bit less that meds every day - with "structured" breaks. This does NOT mean people can take half doses each day for example - the rules of suppression include being "aggressive" - taking full doses - when we treat to not allow resistance while on meds - and the reward for doing so is the ability to back off for a few days.
There is an alternative however. The alternative strategy being done is essentially to treat only when the CD4 counts need the help - for example, start when the Cd4 counts are low, get the counts up by controlling HIV, and then stopping meds, and only restarting when the counts are low again. Some are doing this on their own - we have seen in our meetings presentations summarizing the experiences of some who have done just this. For some it can take a few weeks to fall to the point treatment is again needed, and for some it can take much longer. For some this is dangerous - falls in CD4 counts that are associated with symptoms, and result in falls in Cd4 counts that don't completely recover with treatment... but for others it is a welcome break. And safe. And results is a fair bit of time off meds... allowing recovery from some of the side effects of these still imperfect treatments.
So which strategy is better? We don't know. Should people take meds most days and keep HIV under control? Or should we allow longer breaks treating only for low Cd4 counts?? The NIH has funded a study to attempt to answer just this question. It is called the SMART study - you can read more about it at www.smart-trial.org - and see more details. But it is one of the central questions of our time - how to use these meds to achieve a normal life span with the fewest amount of treatment side effects.
So -- yes, I think there are possibilities for living without daily meds, with a normal life span, or at least one in which the risk of AIDS is very very low. And in time, with more and better meds, hopefully this balance will get even easier...
