Exactly 10 years ago, researchers made their first announcement: they cured HIV patients. Known as a patient in Berlin, Timothy Ray Brown needed a bone marrow transplant to treat acute myeloid leukemia. Doctors took advantage of the opportunity to replace his bone marrow with stem cells from donors with gene-based HIV immunity. It worked: Brown’s leukemia was cured, So was his HIV..Recently, in 2019, a second patient, this time being treated for Hodgkin lymphoma, Healed in London as well..
However, while these are the most famous stories of patients being cured of HIV, their treatment is only one option for many new approaches to tackling the virus and is one of the least widely applied. Bone marrow transplants cannot be given to people who are too invasive and too risky to have a cancer that requires a procedure. Especially considering that most patients who are diagnosed with HIV and receive care can effectively control their illness with drugs. In fact, patients receiving antiretroviral therapy (ART) today have the same life expectancy as those who are not infected with HIV.
Other new approaches have shown the potential to treat HIV more effectively and eventually cure it. This is especially important. This is because not all patients, including those suffering, respond well to ART. Brutal side effects Bone loss, weight loss, liver, kidney and heart problems. “”[With ART]Ryan McNamara, a virologist at the University of North Carolina at Chapel Hill, said:
The reason why HIV is so difficult to treat in the first place is related to how the virus can hide in the body. When a virus attacks, it integrates itself into the cell’s DNA, its genome. From there, it hijacks the internal workings of the cell and replicates itself, creating more HIV billions that continue to attack more cells. This is where antiretroviral drugs can intervene and block certain parts of this process.
But sometimes HIV attacks, integrates itself into the genome, and just … waits. There, it is potentially safe from the immune system and from antiretroviral drugs.According to a recent survey, this is The indications the virus has to block detection.. “It’s going to hide and the amount of medicine we’re currently using isn’t going to find it,” says McNamara.
One of the new strategies to avoid this is to shock the latent virus so that it does not hide. 2020, researchers Effectively achieved latency reversal in both mice and rhesus monkeys In the laboratory. By treating an animal with a small molecule called AZD5582, it is possible to induce a cellular pathway that activates the virus and make it look like an antiretroviral drug.At least there is Three clinical trials are currently underway To test the effectiveness of human latency reversing agents.
This is a more elegant approach than McNamara’s analogy of bone marrow transplants treating patients in Berlin and London. Jurassic Park scene The team wants to resolve the issue by rebooting the system. And while transplanting HIV immune cells can theoretically wipe out and reconstruct the entire immune system, it still cannot prevent HIV hidden in so-called immune privileged sites.
“When you’re weakening your immune system, you’re not hitting its potential reservoir,” McNamara says. “Then you have a real problem in your hands. As soon as the immune system is replenished, the virus awakens and things can move south very quickly.”
Another approach (probably theoretically possible, but not yet practical) is to use CRISPR gene editing tools. Editing the HIV gene from the genome.. So far, research has been done only in mice, but when gene editing occurs in unwanted places ( Off-target effect) Can be kept to a safe minimum, and this technology could one day be used by humans.
Antibodies to rescue
Perhaps the most promising means of HIV research, according to McNamara, Widely neutralizing antibody.. These occur spontaneously in the immune system of a small proportion of HIV patients whose infection does not progress to AIDS. Researchers are studying how to use them to treat other patients.
Because HIV is mutated, it can block the immune system (and retroviral drugs) that are designed to target specific versions of the virus. For most HIV patients, this means that their immune system is constantly in a hyperdrive state and struggling to get rid of moving targets. “It’s a non-stop war between the virus and the immune system,” says McNamara.
However, some patients have a special type of antibody that is continuously effective. “When it comes to broadly neutralizing antibodies, the virus can never win,” says McNamara. “Antibodies checkmate it.”
Potential reservoirs are still their obstacles, but widely neutralizing antibodies ensure that the infection does not progress to AIDS and its risk of infection is low, especially when it comes to repelling the virus. Shows many possibilities with respect to.Some researchers are looking at ways to use them for both deal with And prevent HIV while others are looking at the combination Neutralizing and non-neutralizing antibodies may also have some effect on latent cells..
“Many people ask me: when are we going to get the HIV vaccine? And I often tell them they already have them, they aren’t that great,” McNamara said. Explains. “We think these COVID vaccines, which are 90-95% effective, are corrupt … they are almost raising the bar for immunology as a whole.”
Researchers have been Looking for an HIV vaccine for decades.. The main barrier was finding one with a sufficiently high efficacy rate that pharmaceutical companies would want to invest in and approving it by the FDA. According to McNamara, many vaccine trials are currently 40% effective. That alone won’t work.
In addition to antibody therapy, McNamara says he is most excited about how the field is advancing now that the stigma of HIV infection has diminished.
“It seems that trust has been built between the HIV-AIDS community and the medical community, and this has taken a long time,” says McNamara. “In the early days of the HIV epidemic in the early 1980s, it was ugly. It’s really ugly. And many people, including Anthony Fauci, took a great deal of effort to correct many of these mistakes. “He says a new sense of communication and trust is what he is looking forward to. “Without trust, you can’t do clinical trials. You can’t do new medications.”
How close are we to the cure for HIV? “If you asked me that 10 years ago, I might have said never“McNamara says. “But I have changed my view in the last decade. I think I will actually see healing in my life.”
How wide and fast the treatment can be deployed is another matter. Having a cure, or having a vaccine, is different from doing it all over the world. Edward Jenner discovered the smallpox vaccine in 1796. The last outbreak of smallpox in the United States was in 1949, And the disease was declared globally eradicated in 1980. Jonas Salk developed the polio vaccine in 1952. There have been no cases in the United States since 1979, but the disease is Not completely eradicated worldwide.. How quickly does HIV go away when vaccinated?
“I don’t think we’ll eradicate HIV in a lifetime,” says McNamara. “But by the end of the decade, I imagine we might get reproducible results of treating some patients. Are you doing it consistently? Probably another 10 years. Technology. I think it’s there. “
How close are we to the cure for HIV?
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