For decades after the HIV virus was first identified in 1983, a cure seemed impossible. Much of the scientific – and activist – world’s focus was on ensuring people did not contract the virus in the first place, and later, on antiretroviral therapy for those who had.
One of the main reasons that a medical means of eradicating HIV has remained tantalisingly out of reach is because HIV hides in “viral reservoirs” in the body.
Romas Geleziunas, senior director, biology at biopharmaceuticals company Gilead Sciences, explains this clearly. “A major barrier to curing HIV is its ability to hide and become latent in certain immune system cells that constitute our immunological memory and are with us for life. These latently infected cells are essentially invisible to the body’s immune system and not susceptible to current HIV medicines. If antiretroviral therapy is stopped, latent virus quickly rebounds, and infects new cells.”
People with HIV, therefore, need to take antiretroviral therapy every day, for the rest of their lives. But while being HIV positive has become a chronic manageable condition – for people who know they have the virus, and have access to treatment – it still has psychological and physical impacts on individuals and societies. As a result, research programmes around the world continue to search for safe and effective ways to cure HIV.
In January, Gilead announced the recipients of its HIV cure grants programme, a fund totalling more than $22m (£17.4m), designed to advance the whole field of HIV cure. This fund is supporting 12 new HIV cure research projects, which come from leading academic institutions, non-profit organisations and community groups around the world. A number of these projects look at ways of measuring, reducing or treating this viral reservoir; others consider community involvement in cure research.
One of the projects funded by this programme is based at Aarhus University Hospital in Denmark. It will involve a randomised, placebo-controlled trial using two different drugs that will firstly expose, and then fight, HIV reservoirs. Professor Ole Schmeltz Søgaard is its lead investigator. “Our approach is to expose these hidden viruses, expose cells that are sick. We do this by trying to force the virus to be activated and come to the surface. That is one component. Then, once the virus is exposed, the immune system needs help to kill these cells. Similar to cancer treatment, [these drugs will] help the immune system overcome its limitations and kill sick cells.”
Using two drugs which have already been tested separately – one to expose the virus for activation, and the other to help the immune system to kill the sick cells – the trial will consider whether or not these drugs, used this way, could eradicate HIV.
This trial, which is currently in its preparatory stages, will involve 60 people – in Denmark, San Francisco and Melbourne, Australia – whose HIV is currently at non-detectable levels because they take daily medication to keep it that way.
A particularly promising part of this trial, says Søgaard, is the fact that it is scaleable; the treatment does not involve very expensive therapies but could, if it works, be replicated elsewhere. “If this works out, it can be used all over the world – and not just developed countries with high medical standards,” he continues.
This also aligns with work Gilead is carrying out within its own organisation, conducting early-stage clinical research to identify new agents and strategies.
These projects will not necessarily mean that the virus is eradicated altogether – or at least not in the immediate future. “Current cure research is largely focused on achieving sustained HIV remission without antiretroviral drugs,” says Geleziunas. “In [that] case, patients would not have HIV eradicated from their bodies, but would be able to keep the virus suppressed without lifelong antiretroviral therapy.”
Matthew Hodson, executive director of NAM/Aidsmap, welcomes Gilead’s investment into a wide range of solutions towards the medical challenges of HIV.
“Taking pills daily [for HIV] may not be a huge price to pay for survival but it is a constant reminder of the precariousness of my health,” he says.
And for some, keeping to this treatment schedule is a challenge.
“Despite massive improvements in treatment and, as a result, life expectancy, HIV remains one of the most stigmatised conditions of modern times. This, in itself, can discourage people from testing, leaving them vulnerable to the impact of the virus. I believe that a cure would go a considerable way towards reducing barriers to testing.”
Søgaard is now cautiously optimistic that there will be a cure. “We will get there eventually. It will be a great team effort, with researchers from all over the world. We are all optimistic we will get there one day.”
Content on this page is paid for and produced to a brief agreed by Gilead, a sponsor of the Guardian’s Global Development Professionals Network.
Date of preparation: April 2017 (HIV/IHQ/17-03//1363a)
