November 3, 2012
Eron pointed out other cure strategies currently being worked on, including genetic modification of CD4+ cells to limit or stop HIV replication. In particular, using a zinc finger nuclease to artificially disrupt the CCR5 receptor on CD4+ cells in an effort to make them resistant to HIV infection. "That's been done by a company called Sangamo and multiple investigators. The issue is they've never tried to do this in stem cells. They've only done it in peripheral CD4+ cells. I think to effect a cure, you have to do it in stem cells," Eron said.
He also noted two other strategies. "Perhaps there's specific activation of HIV-infected cells using targeted nanoparticles," Eron offered; he said researchers were working on that idea. "There may be some cytokines like interleukin-7 (IL-7) and interleukin-16 (IL-16) that could be given with [antiretroviral therapy] intensification to effect a cure," he added. "There are other ways to go forward, but we've a long way to go."
While not technically a cure, patients who start treatment immediately after becoming infected show a better response to HIV. Notably, a group of patients in France known as the Visconti cohort showed an ability to control HIV without treatment, much like elite controllers, Eron said. This was after they started treatment within 10 weeks of infection and stayed on treatment for an average of three years.
These patients present an interesting alternate road to a potential cure, Eron said. "Perhaps patients treated during acute infection might be the opportune patients to at least be the first ones to be cured. The reasons I say that is most individuals are infected with a single variant, and if you put them on therapy soon enough, that single variant does not get a chance to diversify."
Eron continued: "CTL [cytotoxic T cell] responses early are robust and could be preserved, as might be CD4+ cell responses. Persistent activations may be less. The size of the reservoir is smaller. We have seen that. So it's possible that these people treated during acute infection and suppressed for a long period might be ideal candidates for a cure soon."
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
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