Although they announced no new breakthroughs in the search for an HIV cure, researchers at the University of California, San Francisco at amfAR’s 2017 HIV Cure Summit, held in San Francisco on November 28, 2017, voiced optimism that a cure will indeed be found—just not soon. “It’s going to take a long time,” said Rowena Johnston, PhD, Vice President and Director of Research at amfAR, but she touted the work of the group’s Countdown to a Cure for AIDS Initiative, whose goal is to develop the scientific basis for a cure by 2020.
The bulk of a panel discussion moderated by long-time HIV/AIDS researcher and clinician Paul Volberding, MD, currently the Director of the Center for AIDS Research at UCSF, centered on research into “reservoirs” of hidden HIV-infected cells. A “reservoir” is a collection of sleeper cells in the body; that is, HIV-infected cells that are undetected in blood tests and that thus are resistant to typical ART treatment. Such reservoirs have been found in lymph nodes and in the stomachs of HIV-positive patients. Since the sleeper cells are undetected in blood tests, researchers at UCSF—including Warner C. Greene, MD, PhD, who said that the key to a cure is finding and eradicating the reservoirs of infected cells—are looking for ways to utilize imaging technologies, such as MRIs, to locate the reservoirs.
Dr. Greene pointed out that the next step, after the location of the reservoirs of HIV-infected cells, is to use a “latency reversal agent” (LRA) to “wake up” the sleeping cells, to “shock” them out of hiding so that they can be killed by the immune system or some intervention, such as ART. Thus far, the LRAs used in “shock and kill” research have proven to be very toxic, but he said a newer, less toxic LRA is already in Phase II trials at UCSF. He proffered that any cure hinges on removing these reservoirs of sleeper cells and expressed certainty that such LRAs “will be part of the cure.”
One of the problems of such trials is, patients are required to cease whatever ART they have been taking prior to the trials. Many patients are, understandably, uneasy about stopping the ART treatment that has prolonged their lives beyond expectation, with no guarantee of the success of new treatments and/or a cure. Jeff Taylor, a thirty-six-year long-term survivor and advisor to many research groups, including the amfAR Institute for HIV Cure Research and the Ryan White Planning Council, reminded us that 2017 is the thirty-year anniversary of the advent of AZT—and, as someone who volunteered for early trials of AZT, reminded us of how toxic AZT proved to be.
Asked why amfAR has instituted the Countdown to a Cure for AIDS program, Dr. Johnston remarked that the estimated cost of caring for just one person with HIV/AIDS, including the costs of clinicians, testing, and medications, is over $400,000 over the course of the patient’s life, an unsustainable reality. Talking about San Francisco’s “Getting to Zero Consortium,” whose eventual goal for the City is zero new infections, zero deaths, and zero stigma, Dr. Johnston stated that “[t]he stigma [associated with HIV] is the hardest to get rid of,” but that eradication of the stigma as well as the virus is part of amfAR’s goal.
For more information on amfAR’s and UCSF’s Countdown to a Cure for AIDS program, log on to www.curecountdown.org.
—Reporting by Hank Trout
Hank Trout, Editor at Large, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a thirty-seven-year resident of San Francisco, where he lives with his fiancé Rick. Follow him on Twitter @HankTroutWriter.