Opinion:
Is A Cure for HIV/AIDS Possible?
by Dr. Harold Smith
The answer to your question is that a cure for HIV is theoretically possible but it has proven difficult. It is also important to appreciate that seeking a cure is a very recent focus. The methods for ‘cure strategies’ are still in the ideation stage and being vetted. First and foremost, one must come to grips with the reality that only one adult living with HIV has been cured. Timothy Brown, formerly HIV+, was undergoing treatment for cancer. His physician decided to given him a bone marrow transplant from a donor whose cells were naturally resistant HIV. The procedure, which had to be repeated, cured Mr. Brown of the virus, but was painful, debilitating, and life-threating. This was essentially an impromptu, one-person, clinical trial and unconventional in its approach, especially in 2007 when management of HIV+ patients focused on suppressing the amount of virus in a patient’s blood, not cure. From logistical and a cost perspective this approach is not practical on a national or global scale.
Over the past 30+ years, academic, government and industrial scientists have focused on identifying the vulnerabilities in the HIV life cycle that might be targeted with drugs or vaccines. There is no doubt that the arsenal of anti-retroviral drugs currently available have saved lives and are a remarkable achievement. The first drugs were toxic and required multiple doses with several different drugs in combination. The antiretroviral therapies (ART) used most frequently today are the result of seeking more effective and less toxic drugs for single daily dosing and are considered by the industry to be well tolerated by patients. As grand of an achievement as this is, none of these are curative. While an infection with HIV is no longer a ‘death sentence’ for those with access to ART, it does mean taking drugs for life and living a life with the virus and the inconveniences of side effects and increased likelihood of metabolic diseases, cancer and premature aging.
It is my opinion that curing HIV will require a new mindset from the approaches taken for treatment. It is critical to understand that all ART were developed with the mindset that these drugs will be taken for the life of the patient. A cure requires more than reducing the amount of virus in a patient’s blood. A complete cure such as is the situation for Mr. Brown (complete elimination of HIV from the body) or a functional cure (only disabling the ability of infected persons to produce infectious HIV) may have to involve a limited period of more aggressive treatment and the acceptance that there may be serious side effects for a short term such as with curative treatments for other diseases like cancer.
The major stumbling block for curing HIV is the virus can go dormant in reservoirs that are reactivated when treatment is stopped. The recent “Kick and Kill” strategy for cure involves activating (Kick) silent HIV reservoirs throughout the body and then (Kill) killing the cells that harbor these sources of virus. This approach requires the research and medical community to broadly explore what is required for the Kick and whether the Kill therapies are strong enough to prevent virus released from reactivated reservoirs from forming new reservoirs. This approach may be limited to patients whose virus can be highly suppressed by ART. Recent gene editing tools (CRISPR) conceptualized to cut the HIV DNA out of a patient’s chromosomes will likely encounter similar logistic hurtles in how to access HIV reservoirs cells throughout the body.
The point is that it has taken this long for the research community, the pharmaceutical industry and the HIV community to even talk about curing HIV because of the dire need to bring the disease under control. The research funding climate and general conversation therefore were not focused on cure until recently. Unfortunately, overzealous proclamations of unsubstantiated cures by the mainstream media have become a sideshow that runs the risk of generating skepticism in the public. It also has to be acknowledged that a cure for HIV will be disruptive of an industry who have made significant investments developing the existing ART and new formulations thereof. Cure will require discovery and this will depend on risk-tolerant investment by private and federal sources that are not limited by conventional thinking of HIV in terms of long-term treatment regiments. As the history of this plague teaches, activism is important for motivating industry, the federal government and the FDA with a sense of urgency and need to rapidly and broadly explore all options. Treatment activism, re-envisioned as cure activism, will play a critical role in reshaping opinion and motivating an all-out exploration of ideas.