Eye on the Future

Towards an HIV Cure 2015 provides strategies to watch for

by Jeannie Wraight

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[dropcap]T[/dropcap]owards an HIV Cure is an initiative of the International AIDS Society (IAS) formed to help direct and facilitate discussion, research and policy to advance and accelerate a cure for HIV. The project hosts the annual “Towards an HIV Cure Symposium,” where HIV cure research is presented and discussed. This year’s conference took place on July 18 and 19 in Vancouver, Canada, preceding the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Over 300 participants, including clinicians, activists, policymakers, and cure researchers, attended the symposium.

Early ARVs
The most widely publicized news from the symposium regarded an eighteen-year-old perinatally infected French-Canadian woman. The unnamed young woman was given ARVs at three months of age and discontinued therapy at 5.8 years old. She has currently been in remission for twelve years.

So far researchers found two important factors with her immune response to HIV. Her haplotype, which measures how susceptible her cells are to HIV infection, is normal, and not one that makes HIV slow to progress. Second, like other post-treatment controllers, her CD8 cells are significantly unresponsive to HIV, giving off a low level of chemical messengers like Il-2. This differs from elite controllers (those able to control HIV infection without treatment) who have high levels of these messengers and a haplotype that generates low viral loads and slow HIV progression. Unlike the Mississippi Baby, she does test positive for HIV DNA, although her plasma HIV levels are below the level of detection even with extremely sensitive assays. The relevance of the differences between the two post-treatment controllers as well as with elite controllers is yet unknown.

Other patients known to be experiencing post-treatment remission include twelve of the fourteen individuals from the Visconti Cohort. The average remission in this group is ten years. There is also a documented case of a woman in Argentina who began ARVs after she was diagnosed with AIDS. She is the only person known to achieve remission after experiencing advanced HIV disease. At last report from the XX International AIDS Conference in 2015, she had been in remission for eighteen years. This woman no longer produced antibodies to HIV nor had HIV provirus in PBMC cells.

These cases, though seemingly rare, are important in understanding HIV remission and researchers say they may help to better determine who may experience post-treatment remission and what markers may eventually show who could come off of ARVs without viral rebound.

Broadly Neutralizing Antibodies
John Mascola, MD, Director of the Vaccine Research Center at the NIH, spoke of the role that broadly neutralizing antibodies may play in HIV. Dr. Mascola stated that the research over the past five to ten years has shown that some people living with HIV produce very potent antibodies that help them to effectively control HIV. These antibodies have been collected and stored and are being used for research to discover ways they can help to prevent and treat HIV. There are three ways that these antibodies could play a role in HIV treatment.

1. Given early with ARVs, they may be able to get the virus under control quickly and/or have an effect on the size of viral reservoirs.

2. They may help with viral suppression along with ARVs, possibly allowing for the ARVs to be limited or withdrawn.

3. They have some effects that ARVs don’t have, such as the ability to mediate killing off HIV-infected cells. If given with drugs that induce expression of virus from cells, they may be able to reduce the size of viral reservoirs.

Gene Editing
Christopher Peterson, PhD, of the Fred Hutchinson Cancer Research Center, discussed stem cell editing and transplantation that his lab is performing on primates. By removing the CCR5 co-receptor gene, it makes it difficult for HIV to enter cells that utilize this co-receptor. They then transplant the cells back into the primates with the hopes that enough protected cells will prevent the virus from spreading and will enable the immune system to mount a better immune response. It’s very early on in this research and early stage human trials are expected in the near future.

Partnerships
Partnerships between pharmaceutical companies, biotechs, universities, foundations, the government, and the HIV community are beginning to surface. These partnerships are becoming an important source of funding and collaborative research and will hopefully expedite and streamline research. One such recent collaboration involved GlaxoSmithKline and the University of North Carolina at Chapel Hill where a cure center is being built, and a new pharmaceutical company called Qura Therapeutics formed to expedite drug development that may arise from the collaborative research. Another initiative is the amfAR Institute for HIV Cure Research that will be located at and will work with a yet to be named institution. A separate Cure Center is expected to be announced later in the year.


 

Jeannie Wraight is the former editor-in-chief and co-founder of HIV and HCV Haven (www.hivhav- en.com) and a blogger and writer for TheBody. com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in New York City.