Cipriano Martinez
Towards an HIV Cure with Optimism
‘Freedom!’ ‘hope’ ‘the ability to live life to the fullest’ were the top responses to the question ‘what would a HIV cure mean to you?’ when I asked community participants at AIDS 2018 in Amsterdam. Engaging in HIV cure efforts for many of us means growing our shared freedom, hope and love. As a person who shares this community sentiment, what follows is an optimist’s gaze of progress towards a HIV cure.
From Berlin to Amsterdam via hope
The Berlin hope – Timothy Ray Brown – is often mentioned in conversations on HIV cure. Living proof that a person with HIV can be cured has become a rallying cry when we need motivation. What’s exciting is the very real prospect that Timothy will have some friends very soon. This is highly speculative on my part, but based on a presentation from Monique Nijhuis (University Medical Centre Utrecht, Netherlands) at the HIV Cure Research with the Community Workshop. The IciStem cohort that she presented about aims to replicate and learn from people in similar circumstances to Timothy. Over the next year, some participants will stop ART and be studied carefully to determine the impact and outcome of the intervention. It’s necessary to acknowledge and remember the acts of love given by the 37 participants of this research, of which sadly 18 are no longer with us. We remember, we thank you deeply and pass onwards your courage, hope and love.
Another strong emerging cure hope is the ongoing development of broadly neutralising antibodies (bNAbs). This strategy is about copying effective HIV antibodies and inducing them into our own immune system. Building up our own immune system to control HIV without taking ART. In a session titled ‘How Far are we from HIV Remission?’, Michel Nussenzweig (Rockefeller University, New York City, U.S.) spoke about the results of combining two bNAbs which work on different components of the HIV viral envelope. The possibility that combining 3-4 existing bNAbs could lead to robust post treatment control of HIV for many years (i.e. HIV remission) is being explored.
At the same session there was a terrific update on lessons from the VISCONTI trial on post-treatment controllers. The VISCONTI trial studies people that have been treated early with ART (less than 12 months from diagnosis) who then come off their medication after years of treatment and are able to maintain an undetectable viral load. Insights from Asier Sáez-Cirión (Institute Pasteur, Paris, France) included the description of which HLA alleles (genetic immune components) may predict post treatment control. This could mean that 5-15% of people treated early with ART could be post treatment controllers and we may soon have the markers to identify them. Our communities may need to prepare for people to enter HIV remission.
Another great development discussed at AIDS 2018 was the prospect of combining a ‘kick and kill’ strategy with a subsequent ‘block and lock’ strategy. The session to look out for is titled ‘Eliminating HIV Latency: Shock & kill or block and lock?’. Both strategies are still in their early development phase and are still the focus of independent research. It was great to hear from Tony Kelleher (Kirby Institute, UNSW, Australia) about block and lock with gene silencing.
Looking to the future with love and urgency
Even though AIDS 2018 didn’t produce a breakthrough media frenzy, the ongoing dedicated research into HIV cure is exponentially expanding our human knowledge. As a confident optimist, I believe this will eventually lead to a classic HIV cure. Urgency in this space matters. A million people with HIV die every year despite all our HIV prevention efforts. Resting is not an option. Pushing a cure out by 20 years means another 20 million dead. This is not acceptable to a human family that chooses to love one another.
Stay engaged. Be vocal about the need for an HIV cure. When appropriate, participate in HIV cure trials. Keep yourself educated through websites like HIVcure.com.au and the Treatment Action Group and join community workshops towards a HIV cure. Lastly, never give up. Keep giving and acting in love to one another. Growing freedom, hope and love is our HIV journey.
.png)