December 15, 2014
Ever since the Berlin Patient had HIV eradicated from his body, we have been waiting for an announcement of the second cure.
After a sort of Berlin Patient-like stem cell transplant in a couple of patients in Boston was followed by rebound of the virus after cessation of HIV therapy, all eyes were on a toddler born in Mississippi with HIV in her blood but none detected after a break in her therapy. Unfortunately, we learned a few months ago that she too had a recurrence of viremia and was, in fact, not cured.
These disappointments have led to a shift in the cure conversation. It is becoming clear that this is not simply a matter of flushing out latent virus harbored in various reservoirs. Increasingly, we are talking about so-called functional cures, wherein the virus is not eradicated but control of replication is achieved without the need for continuous medication. More and more, there is discussion of a critical need to provoke immune responses that can partner with other interventions, such as those aimed at reducing latent virus pools. Vaccines and gene therapy are now being pursued toward this end.
It has been a sobering year for cure research, and an adjustment of expectations and strategies has followed. It is likely that incremental steps rather than a huge leap will lead us to a true cure.
What are some other top clinical developments of 2014? Read more of Dr. Wohl's picks.
David Alain Wohl, M.D., is an associate professor of medicine in the Division of Infectious Diseases at the University of North Carolina and site leader of the University of North Carolina AIDS Clinical Trials Unit at Chapel Hill.
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