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12 Jul 2016

AIDS 2016: International AIDS Society releases HIV cure research roadmap

A comprehensive new strategy, developed by the International AIDS Society and published online today in the journal Nature Medicine, presents key priorities for research to develop what experts consider to be now of the most important global health goals of our time – a cure for HIV.

The new IAS Global Scientific Strategy: Towards an HIV Cure 2016, was developed over two years by a 59-member IAS International Scientific Working Group and reviewed through an extensive global peer consultation process.

The new strategy, which is being published prior to the opening of the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa, analyses recent achievements in HIV cure research, obstacles to a cure and the strategies and priorities to advance the field. Advances in HIV cure or remission research will be a major focus of AIDS 2016, which begins with the fifth annual Towards an HIV Cure Symposium, 16-17 July, in Durban.

Professor Sharon Lewin, Director of the Peter Doherty Institute for Infection and Immunity (Doherty Institute), a joint venture between The University of Melbourne and The Royal Melbourne Hospital, was a member of the working group and joint first author of the publication. She said while the development of antiretroviral therapy (ART) regimens that can control HIV have led to dramatic improvements in the health and life expectancy of those with access to the drugs, treatment is not a cure.

“Being able to maintain lifelong treatment for the 37 million people living with HIV around the world is a formidable challenge economically, operationally and logistically. Not to mention managing adherence, drug toxicities and the persistent immune dysfunction, inflammation and risk of co-morbidities associated with HIV infection,” Professor Lewin said.

“There is a lot of effort going into cure research to try and find a way that people can safely stop ART. This strategy will ensure that scientists globally are working towards the key priorities of cure research that might help us one day reach our goal.”

Nobel Laureate Professor Françoise Barré-Sinoussi, co-chair of the IAS Towards an HIV Cure Initiative, said not long ago, few considered the possibility that HIV cure was possible.

“Today, thanks in part to advances such as the cure of an HIV-infected individual through a stem cell transplant, the identification of a small cohort of individuals who are able to control infection following treatment, and some noteworthy advances in cell, gene and immune therapy, the search for a cure has become a top priority in HIV research,” Professor Françoise Barré-Sinoussi said.

“In 2016, that search is marked by growing scientific interest, an increasing number of novel research strategies in development, and a new optimism that a cure or sustainable remission for HIV is feasible.”

The new IAS Global Scientific Strategy: Towards an HIV Cure 2016 builds on the first IAS cure strategy, published in 2012, which presented the first global roadmap to HIV cure research.  This “second chapter” in the search for a cure outlines the past achievements and future priorities in basic, translational, clinical, and social sciences research, along with a new focus on aspects of HIV cure research that have achieved greater significance since 2012, including:

  • the benefits of early treatment with antiretroviral therapy and the potential of post treatment control;
  • the importance of immunology in HIV cure research, and a call for increased collaboration with immunologists from other fields, such as cancer research;
  • the search for tools that better measure HIV viral reservoirs within the body;
  • the social science and ethical aspects of cure research;
  • and cure research in, and the need to develop approaches that will be appropriate for, resource-limited settings.

Some of the key progress made in HIV Cure research since 2012 and analysed in the new strategy includes:

  • The sustained periods of aviremia in the absence of therapy achieved in an aggressively treated infant, in at least two individuals who have received allogeneic stem cell transplant, and in adults who received several years of ART initiated soon after infection.
  • Evidence that early initiation of ART limits the establishment of the reservoir of HIV infection and prevents the generation of immune escape in latently infected cells.
  • The development of new tools that can quantify the frequency of a cell that carries replication-competent virus, and the demonstration that some biomarkers can predict the time to viral rebound following treatment interruption.
  • Evidence suggesting that HIV continues to replicate and evolve during the first six months of ART but not necessarily during long-term ART.
  • The demonstration in clinical trials that some specific drugs can activate virus or reverse latency but these drugs alone don’t eliminate latently infected cells
  • The demonstration of the safety and potential efficacy of broadly neutralizing antibodies in human clinical trials, and development of novel vaccines that contained and possibly cured SIV infection when administered before infection.

The demonstration that gene therapy with CCR5 modification is both feasible and safe.