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Report and Commentary from the Fifth International Workshop on HIV Persistence During Therapy

February 2012

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Inaugurated in 2003, the bi-annual International Workshop on HIV Persistence during Therapy (aka "the persistence workshop") is the brainchild of researcher Alain Lafeuillade. The meeting presaged the recent explosion of interest in pursuing a cure for HIV infection, a pursuit many had considered quixotic until the case of Timothy Brown came to light in 2008. As has been extensively documented, Brown's apparent cure resulted from a debilitating odyssey of treatments required for the grim diagnosis of acute myelogenous leukemia, enhanced with a mix of insight and good fortune on the part of his doctor Gero Hütter, who was able to provide a stem cell transplant from a donor lacking the major HIV co-receptor CCR5. The sea change wrought by this fortuitous "proof of concept" was much in evidence at the 2011 persistence workshop this past December; the tentative forays into basic science that were once emblematic of the field are now mixed together with more ambitious plans for advancing ideas into the clinic. Perhaps most strikingly, two large pharmaceutical companies -- Gilead and Janssen/Tibotec -- described their use of industrial scale screening to search for compounds that are active against latent HIV. This represents an unprecedented expansion of efforts once confined to under-resourced academic labs.

A number of online resources are available with information on presentations at the 2011 persistence workshop: Lafeuillade runs a website called the Reference Portal on HIV Reservoirs & Eradication Strategies which includes the official abstract book and late breaker supplement along with an expanding number of reports, video interviews and commentary. David Margolis from the University of North Carolina has written a comprehensive report for Jules Levin's National AIDS Treatment Advocacy Project (NATAP) website. Jon Cohen also covered one the most notable presentations in the journal Science.

To try and briefly summarize the top-line stories that emerged from the 2011 meeting:

  • A triumvirate of researchers -- Courtney Fletcher, Mario Stevenson and Tim Schacker -- presented data suggesting that sporadic, very limited rounds of HIV replication may occur in some individuals on antiretroviral therapy (ART) due to poor penetration of certain drugs into the tissues. However, preliminary data were only available from a small number of participants (~4-5) so the implications are still uncertain. According to the clinicaltrials.gov entry for the study, it is now expanding from the original enrollment target of 12 to 40 so additional information should soon be forthcoming. Alain Lafeuillade has posted an interview with Mario Stevenson about the findings, and these presentations were the subject of Jon Cohen's story in Science.
  • An Italian research group led by Andrea Savarino described a retrospective analysis involving 18 rhesus macaques infected with SIVmac251 that participated in various studies combining ART with drugs targeting the viral reservoir. The analysis found an association between the number of "anti-reservoir" drugs animals received and the likelihood of controlling SIV to undetectable levels after ART was interrupted; however only three macaques controlled SIV to this degree so the findings should be considered very preliminary. The workshop organizers issued a press release about the data suggesting that, for the first time, they show that anti-reservoir drugs may be able to contribute to what is now frequently referred to as a "functional cure" (control of viral load in the absence of ART). In an interview with Alain Lafeuillade, Savarino is careful to note that the findings require confirmation in human studies because they could relate to unknown factors specific to the three macaques that controlled SIV in the experiment. 
  • David Margolis from the University of North Carolina presented the first ever data on the use of a histone deacetylase (HDAC) inhibitor named SAHA (aka vorinostat) in individuals with HIV. HDAC inhibitors are at the forefront of efforts to pharmaceutically lure HIV out of latency, so news from Margolis's trial has been eagerly awaited. While very preliminary, and derived from just four participants, the results so far suggest that the approach is able to increase HIV expression by latently infected cells. It took Margolis many years to get the trial started due to concerns about the safety of HDAC inhibitors (which are used as cancer treatments and can cause significant toxicities) but no serious side effects have occurred to date. As Margolis stressed, much more work is needed before any conclusions can be drawn about the promise of the approach.
  • The burgeoning involvement of the pharmaceutical industry in cure-related research -- represented by presentations from Romas Geleziunas from Gilead and Roger Sutmuller from Janssen/Tibotec -- was widely viewed as important news because it has the potential to transform the drug discovery effort by increasing the number of compounds that are being screened by many orders of magnitude.
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This article was provided by Treatment Action Group.
 

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