IAS Cure Workshop Highlights Advances and Challenges
The workshop, co-chaired by Steven Deeks, M.D., University of California, San Francisco, and IAS president and Nobel laureate Françoise Barré-Sinoussi, Pasteur Institute, Paris, was opened by Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases, NIH. In his opening remarks, Fauci stated that a cure that only benefits 0.01% of the population is not going to excite anyone -- it has to be scalable.
During the community literacy session Australian researcher Sharon Lewin, M.D., Ph.D., gave an overview presentation addressing major barriers to a cure, including what actually defines a cure and potential targets and mechanisms, as well as underscoring the importance of assays for future research and the need for these tests to undergo rigorous standardization with labs before going into wider use.
Activist and Positively Aware contributor Matt Sharp talked about his experiences as a cure research study participant, and the challenges that lie ahead, including ethical study design, Analytical Treatment Interruptions (ATI), and informed consent.
Sharp noted that some cure research may be quite risky, with little chance for benefit. He asked what the "reasonable" risks are for HIV-positive individuals who will be participating in early and potentially dangerous cure studies, and how can we best protect them? Developing guidelines for determining when potentially risky treatment interruptions are appropriate is a critical next step, said Sharp, and community input and community advisory boards are essential in ensuring ethical, patient-oriented studies.
An elegant presentation given by Robert Siliciano, M.D., Ph.D., Johns Hopkins University School of Medicine, was perhaps one of the clearest and most concise presentations I've ever seen on the basics of immunology, HIV infection, and the multiple molecular mechanisms which maintain HIV latency. HIV is not completely eradicated from the body by standard antiretroviral therapy because some of it lies resting in memory CD4+T-cells, which can proliferate for an average of 73.4 years in the human body. However, if you stop taking therapy, the virus typically comes roaring back within a matter of weeks. One eradication approach would be to remain on standard ARV therapy to keep the virus suppressed, while at the same time purging these latent reservoirs and blocking them from infecting new cells, so that they would have nowhere to go and eventually die off, ridding the body of HIV. But it's complicated -- the number of latently infected cells may be much higher than previously thought, by as much as 50-fold, according to Siliciano.
Sarah Palmer, Ph.D., Swedish Institute for Communicable Disease Control and Karolinska Institute, gave a presentation on measuring persistent HIV infection, including an excellent slide outlining some of the advantages and disadvantages of the four currently available assays which measure persistence. In concluding her talk, Palmer emphasized that "looking ahead, to determine the effectiveness of curative strategies, our field will need to develop a more standardized assay system which is sensitive, efficient, less costly, and adaptable in local settings."
Other presentations covered recent advances in the development of accurate animal models for use in future cure research, vaccine and immune-based therapies and the role of immune activation and inflammation in viral persistence.
The conference ended with a slightly unorthodox, yet immensely informative and entertaining presentation by Fred Verdult of Amsterdam on the psychosocial benefits of a cure for HIV. Verdult, after finding out he had HIV in 1998, started Volle Maan, an organization that conducts studies and communication projects on health and disease to encourage people to live full and worthwhile lives. Volle conducted a survey of 458 individuals in the Netherlands asking how important to them a cure for HIV is, why a cure is important, and which type of cure is preferred.
The majority of the survey respondents indicated they were in good health, with only 14% stating that their health was poor. Seventy-two percent said that it was very important to them to be cured of HIV, while another 22% said it was somewhat important. Yet when asked about how a cure might look, participants had varying responses. 95% thought that a total cure without any risk of future transmission or infection very desirable, while only 41% considered it desirable to have a cure that had no risk of future transmission but carried a risk of future infection. The survey also asked about disadvantages of living with HIV -- the risk of experiencing health problems in the future was the number one answer, while psychosocial effects such as stigma and the risk of infecting someone else were also highly ranked.
Deeks closed the two-day workshop by declaring Verdult's presentation the "highlight of the meeting," and remarking on the spirit of collaboration among the attendees. Barré-Sinoussi said that next steps include the efforts of the working groups, including a newly added social sciences research team and an ethics working group, as well as a call for more cure research funding and collaboration. The next IAS Towards an HIV Cure workshop is scheduled for immediately prior to the 2013 international conference in Kuala Lumpur, Malaysia.
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