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Cure for HIV and Aids (CURE)
Jul 25, 2007

Hi Dr Bob,

I bet that you are an angel sent from heaven to help people answer questions concerning this plague.

I am negative myself (I think, but all my "acts" were protected, so I hope i am safe)

Anywasy, I like to hear your opinion towards the cure for HIV and Aids.

Is it, in your opinion, a safe assumption that there will eventually a cure for the deadly plague? If you are to make a guess (educated, from your expertise), how soon do you think it wil be before we see an effective druf or vaccine for this?

Is there any online information available towards this that you can share?

Thanks!

Response from Dr. Frascino

Hi,

"Anywasy"???

As for my opinion towards the cure for HIV and AIDS, well, my opinion is that I want a cure yesterday! Unfortunately that's not the reality of the situation.

Will there "eventually" be a cure? Yes, I think there will. However, "eventually" can (and probably will) take a very long time getting here. More effective drugs and vaccines are indeed "on the way," but my concept of a cure is something that's available and affordable for all who need it. That kind of product is not even on the distant horizon. Despite that, my optimism remains high. After all, it can't be any more difficult than hunting down and destroying Lord Voldemort's horcruxes while avoiding the temptation to acquire the Deathly Hallows. (OK, anyone who hasn't read the seventh and final volume of J. K. Rowling's brilliant Harry Potter series is presently scratching their heads at my last comment. Sorry about that folks. One of Luna's Crumple-Horned Snorkacks made me do it.)

I'll post some questions from the archives about "cure" below as well as some very current information recently published in AIDS Treatment News.

Stay well.

Dr. Bob

Cure? May 13, 2006

Just a quick question doc- is there any word of a cure coming in the near future for HIV/AIDS? I wondered if any of you had checked your crystal ball thats all ;)

keep smiling my dear

Response from Dr. Frascino

Hi,

Is a cure coming? I certainly hope so.

Is a cure coming in the near future? Unfortunately no. I see no signs of that; however, that should not dampen our optimism, but rather sharpen our resolve to be here for the cure.

As for smiling and balls, well, I can say I always smile when checking my balls, but isn't that an entirely different topic?

Dr. Bob

CURE??????? Oct 25, 2006

Dr. Bob,

I did a web search and found several products that claim they can cure AIDS. What do you know about immunoboost and other immune cures. Shall I send away for the information. I really want to be cured.

poz-guy

Response from Dr. Frascino

Hey Poz-Guy,

Another Web-based AIDS cure??? Gosh, that's like the 5th one this week!

Poz-Guy, think this through rationally. If any of these products were actually a cure for AIDS, don't you think we all would have heard about them from a slightly more reliable source than an obscure Web page wanting you to send away for more information? Gee . . . do you get the ginsu knife set or a Vegamatic if you respond in the next 10 minutes? And do you really think Magic Johnson would still be HIV positive if a cure existed?

Scams like these have been around since the earliest days of the epidemic when a Web was nothing more than a spider's home or something hypocritical GOPers got themselves tangled in while trying to lie their way out of yet another scandal.

When the cure for AIDS does arrive (and it eventually will!), I assure you that you won't have to do a Web search to hear about it. I'll bet Fox News will even have to mention it while trying to blame the entire pandemic on Godless sodomites or Clinton's penis or whatever . . . .

For now, Poz-Guy, keep your Web browser tuned to reliable HIV-information sites, like The Body. We'll keep you informed with facts and science, rather than hype and science fiction!

Be well.

Dr. Bob

Funding the Cure Jan 22, 2007

Dear Dr Franscino

First up, many thanks for your advice on this website. As an HIV+ medical student qualifying this year, you're a real role model for me.

It seems to me that HIV has been largely turned into a chronic disease - I was reading a Danish study that suggests I can expect to live another 40-odd years so long as I avoid HCV and take my pills. However, looking around on the internet, I'm dismayed at how people seem to have given up on eradicating HIV from the body. Huge amounts of money seem to be flowing towards vaccine and microbicide research and looking after people with HIV, which is all really encouraging. But what about those of us infected already? And those in developing countries when a vaccine does come? Will they just be left out in the cold, when the problem seems "solved" by a vaccine?

The American Foundation into Aids Research's recent decision to grant just $1.5 million to viral eradication studies was characterised as "bold". Surely we can do better than this? I guess my question is "who can I donate to who will fund research into the hard questions that might lead to HIV eradication"? I don't fancy 40 years of taking pills every day and their side effects!

Cheers!

Matt.

Response from Dr. Frascino

Hello Matt,

I agree with much of your comment. However, if you are thinking the HIV/AIDS problem with be "solved" by a vaccine anytime soon, think again. Even with increased funding for vaccine research, an effective preventative vaccine is still not even on the distant horizon. Ultimately, we will need an effective preventative (and hopefully therapeutic) vaccine to end the pandemic, as there appears to be no feasible way to provide treatment to the 40,000,000 HIVers alive today. I agree viral eradication ("cure") should be one of our research strategies it is underfunded at the present time however, it should not be our only research initiative, due to the complexities of that lofty goal. We must also continue to fund research on prevention, treatment and vaccine strategies.

Regarding research for a cure, there are many organizations trying to address this issue from many different angles. The organization you mention, American Foundation for AIDS Research, is one such organization.

I'll post several questions from the archives below that address this topic.

Good luck.

Dr. Bob

Are they forgetting us? Aug 22, 2006

Dr Bob, I think "any hiv research, trials, etc" is a good thing, although I must admit my worry (sounding very self absorbed I know) about the focus being purely on a vaccine to "protect" from hiv...but where does that leave us> What about the people living with hiv? Is that no longer a priority? A vaccine would be incredible and I'd be thankful to hear of it if it were created.... But what about the people with loved ones or people living with hiv.....are we still in the researchers thoughts?

I would liek to hear Dr Steve's views on this also, as him having the love of his life live with hiv - is there enough being done out there to help the infected in the future? or as bad as it sounds, it is "bad timing" for us....and the infected are jsut left to "die out"?

Your thoughts?

Jason.

Response from Dr. Frascino

Hi Jason,

Do I think scientific HIV research is forgetting about us, the virally enhanced? No, not really. Do I think enough is being done? No, definitely not.

Regarding HIV vaccines, there are actually two different types under study "preventative" vaccines to protect against infection and "therapeutic" vaccines to bolster the immune system of HIV-infected folks to better fight the virus.

The reason you are hearing so much information and emphasis being placed on prevention interventions, like preventative vaccines and microbicides, is primarily because that was one of the key themes stressed in last week's International AIDS Conference in Toronto. Also, it's a question of economics. The pandemic has been allowed to spread so widely over 40 million currently infected and an additional five million expected to join the ranks this year that it has now become unfeasible to provide effective treatment for the burgeoning population of HIVers on the planet. Ultimately the only way to get a handle on this still volatile and dynamic pandemic is to prevent new infections, while simultaneously treating those currently infected.

Do I think it's "bad timing" for us? No, not at all. In fact, without the miraculous advancements we've made over the past decade in treating HIV, I certainly wouldn't be here today. So in some ways, perhaps I'm living on "borrowed time" already. I'm encouraged by organizations like the Clinton Foundation's and the Gates Foundation's focus on HIV/AIDS. We certainly can't rely on Dubya's faith-based approach to the problem, which often seems more focused on saving souls than lives.

So let's continue to advocate for (or perhaps, better yet, demand) a cure! Personally I plan on succumbing to old age, not HIV.

To get Dr. Steve's views on this or any other topic, just submit your question to his attention in the Tratamientos Forum. (Yes, he speaks English as well as Spanish!)

Stay well, Jason. Be here for the cure, OK?

Dr. Bob

Enough being done??? Aug 25, 2006

Hiya Dr Bob, In regards to the question posted "have they forgotten us"....you said "is enough being done regarding the virally infected people...no". Why not? It seems there are things being looked into and research etc...but WHY SO SLOW? Everytime I get a glimmer of hope about a hiv boost for the infected or even a vaccine/cure...they add on the end that it will be years away...10 or so. Dont people know how many people are dying all over the world from this? What more do you think can be specifically done, and what can we all do? It really is a race against time for so many of us....do you and Steve sit and talk about how frustrating / terrifying that can be? This race against time? It doesnt feel people are moving fast enough on this?

Robert.

Response from Dr. Frascino

Hello,

It's a question of resources and perceived need. For instance, look what happened with the mere threat of avian flu or SARS. It set off a coast-to-coast panic and prompted a Federal governmental response to draw up contingency plans and stockpile medicines. And then look at the national response to the emergence of AIDS. It ranged from indifference to hostility. In some ways HIV-positive folks have been treated like Katrina victims stranded on rooftops waiting for help that should have arrived long ago.

HIV has proven to be a very crafty adversary; however, that we have allowed a totally preventable disease to spread so widely and wildly and cause so much devastation and heartache is a sad commentary on modern man's priorities and morals. Why isn't more being done? Primarily because those who could do more tend to feel HIV/AIDS is someone else's problem.

What can we do?

1. Increase AIDS awareness among your friends, family and acquaintances.

2. Advocate for increased spending on research and development of treatments and a cure. Demand action!

3. Vote the anti-science, faith-based looneys currently in office out! (ASAP!)

Dr. Bob

How About Clinicians for a Cure? Nov 7, 2004

You are giving your life for your work, and I say thank you. But I think that most cliniciansd and researchers seem jaded, and leave activism for medical progress to the patients. Do you think docs could get involved in campaigning for change?We are not gonna get real progress from the big funding sources; the last thing they seem to want to do is look at this disease in a rational manner and coherently fill in the gaps in our knowledge. But a consortium of researchers-- Aids Docs for a Cure say --- would really get things going. In a way it might be easier for clinicians to get involved in this. Researchers have to depend on not rocking the boat from funding sources.

What do we mean by a cure? The chance for people infected with HIV to live in good health again.

It seems that there would be two main ways to get a cure, either change the virus or change the immune system, or both.

Most research so far has been on killing the virus. This has resulted in some progress, in the form of expensive, toxic drugs, but it is short sighted. When has medicine ever succeeded in eradicating a virus? We've won the war on some diseases, such as polio, with vaccines, but we never learned how to kill the polio virus. We can't even kill the common cold.

Doctors always say take HAART, better, less toxic medicines are coming. Or maybe some kind of treatment interruption can help, say starting when t cells reach 200 and stopping when they go up to 350, or starting early stopping when they go up to 800 and then starting again when they drop to 400. This will win some time off meds but its not a solution. What medicine is nontoxic enough to be taken daily for decades? Let's hope those medicines come along soon, but this should not be the only funding focus.

Adam Arkin et al are looking at engineering the hiv virus to attack itself. Now that is a promising area for research. But we need more than one team working on it. There are many many teams working on tiny variations of the same antiretroviral drugs.

Numerous scholars have reengineered the virus to deliver gene therapy for other diseases. Thats right, they change the AIDS virus so it won't cause AIDS but may deliver an anti cancer or anticystic fibrosis gene. Numerous scholars have reenigineered the virus so that it will infect various species of animals for testing or in order to more safely study different properties. Its time to put much more into trying to change the virus so that it will be harmless to man. There are many viruses that can live in us without causing serious problems. Maybe HIV can become one of them.

Alternatively,maybe the immune system can be changed so the virus won't damage it so badly. Efforts in this area include vaccines and gene therapy. There is lots of work now on vaccines after years of stalling. So far they don't work well. HIV mutates rapidly and specifically attacks the immune system so its hard to train the immune sytem to fight it. There should be more work on this, but maybe its the wrong approach. Maybe it would be better to train the immune system to tolerate HIV. Sound crazy? Well the sooty mangabey lives for 20 years or more with a high viral load and never gets sick because the body seems to ignore the virus. Most of the destruction of T cells in HIV seems to be due to an overly intense immune response rather than too sluggish a response. Over a certain number of years the immune system gets worn out and then the CD4 cells are gone. This is why immune suppressant drugs such as cyclosporin and prednizone sometimes help. But they have side effects. If instead we could train the body just to relax, accept the hiv as a passenger and stop overproducing CD4s we might be able to get a steady healthy number. See Feinberg, M 2002.

Also we need to look at ways to stop the apoptosis of uninfected cells. Apoptosis iswhen the cells die off on their own without being infected. HIV seems to somehow tell unifected cells to die, while keeping the infected ones alive.

The hot thing now seems to be drugs to drive HIV out of latency so HAART can fight it. Hello?! How about putting it INTO latency and keeping it there!!! Oral herpes and Epstein Barr stay latent for decades. Yes, in some people they may contribute to cancer, chronic fatigue or MS, but in most people they are relatively harmless. If we could make HIV truly latent this would be almost as good as a cure.

Gene therapy includes engineering CD4s that won't be killed so easily, and there are several current trials of this. Its not easy, but it has had some good successes. Also the cloning of CD4s and replacement of them.

If you look at the latest stuff there is lots of hope. But lots of these ideas were being tried years ago. But in small studies. The only thing that seems to get real support is variations on the same antiretroviral drugs. And even there, most of these are me-too drugs that don't represent much of an advance. Some of them are at least good to fight resistant virus but thats not even true of most.

Any clinician or researcher who is serious about helping people should try to find ways to get more studies of the alternative ways to fight HIV disease. Temporarily killing viruses is not the only way to control AIDS, maybe not even the best.

Response from Dr. Frascino

Hello,

Thank you for your comments. Since I am an HIV/AIDS physician specialist, a Board Certified Clinical Immunologist, an HIV/AIDS researcher, an HIV/AIDS advocate and activist, an HIV/AIDS philanthropist, and person cohabitating with the virus (HIV positive), I'll add a few of my own comments to yours.

In general, I think we do get what we demand. In the bleak early days of AIDS, those diagnosed typically survived no longer than a year. We demanded something anything to help. Given the grim prognosis of those days, we were pleased to see the development of AZT that extended life for about six months. We demanded more. A decade or so later, multiple other drugs followed and HAART treatment promised years of extended life. Soon we realized how difficult and toxic these therapies are in the long run. We demanded simpler therapies and that's what we got once- or twice-a-day regimens with fewer pills and fewer, although still significant, side effects.

These "improvements" have taken the pressure off the urgency of and search for a cure. However, although I agree therapies today are far superior to those a decade ago, anything less than a cure is suboptimal and unacceptable. As the arsenal of new drugs and strategies continues to grow, we must continue to ask, "Are these new therapies minor advanced or real progress toward a cure?"

Your question reminded me that even the word "cure" is often absent form the vocabulary of many HIV/AIDS advocates, activists, community leaders and scientists. I don't mean to dismiss the ongoing "minor advances," as I have certainly benefited from them, and until there's a cure, they are certainly needed and welcomed. Minor advances after all are at least advances, and advances are progress. What they are NOT, however, is enough.

So when will there be a cure for AIDS? I don't know. But I do know we get what we demand. The demand for a cure must be reinstated into our community's lexicon at all levels. As we reclaim it, we must hold our elected leaders, activists, physicians, researchers, scientists and bureaucracies that determine research priorities accountable for making it a goal. History clearly shows HIVers hold incredible power, even when the odds are stacked against us. We and our advocates have revolutionized the system that evaluates and approves new drugs and that created mechanisms for earlier access to experimental therapies. The current administration (oh lordy, did we reelect those cuckoo clocks again???) hasn't been friendly to AIDS, either for research or for programs that serve positoids. It's time to reinvigorate the quest for a cure among ourselves and inspire others who have never known a world without AIDS to realize a cure is possible!

Our history proves that a few people can make a difference. More people can make a greater difference. So what do we do right now? How do we ensure a cure will be realized today as opposed to tomorrow? This year rather than next year? I'd suggest the first step is believing that we can make a difference, finding our voice and simply trying. There is no harm in trying; there is merely the possibility of success with no downside. If we fail, we are no worse off than yesterday. Change only happens when we find the will and courage to make it happen. Join me; demand a cure today. (www.concertedeffort.org)

Dr. Bob

Is Cure Possible for HIV?

By David Scondras, hope@sfac.org

Summary: The c-word is coming back due to new research, after a decade of banishment.

----------------------------------------

Once again we are hearing about efforts to eradicate HIV, at least in some people. These efforts are being made, not by marginal actors, but by some of the country's top doctors, such as Anthony Fauci, longtime director of many HIV research efforts at the National Institutes of Health.

On May 24th the Bloomberg report (Bloomberg.com) headlined the issue this way: "Top U.S. Scientist to Use New AIDS Drugs Seeking Cure" [1].

For a summary of scientists' efforts exploring the possibility of eradication, see [2].

So what happened?

For many years scientists have understood that after HIV gets into someone's body, it starts infecting lots of T-helper cells. They are sometimes called CD4+ T cells.

T-helper cells are the cells that recognize that the body has been invaded by some enemy germ. If these kinds of cells are significantly reduced, the body is unable to recognize many illnesses, which start infecting a person with HIV. This is what we call having "AIDS".

The way HIV works begins with HIV inserting instructions into these T-helper cells on how to make more HIV. These instructions are known as 'provirus'. They are kind of the brain of HIV and it is these instructions that turn the cell into a factory that can make HIV.

The number of these factories is dramatically reduced soon after an HIV-positive person takes strong HIV medications. Unfortunately the medicines we have today do not eliminate all of the provirus. If you checked the cells of people with HIV who are taking antiviral medicines, you'd see that although HIV medications have eliminated most HIV from their bloodstream, some cells with these instructions on how to manufacture HIV remain. It is still unclear why these cells containing instructions remain while most of the virus has been eliminated. The cells that have provirus but are not producing HIV are called 'latently infected'. They have the ability to spring into action at any time.

Scientists have at least two different theories that might explain why HIV in someone's body does not disappear altogether with the use of antivirals.

The first theory is that these latently infected cells can hang around for as long as twenty or thirty or forty years. As soon as someone stops taking antiviral medicines, these cells can spring into action and manufacture HIV.

The second theory is that the medicines we have been using until now do not shut off all HIV reproduction, just most of it -- and that is why when antivirals are stopped, the virus comes back.

The first theory makes us pessimistic about getting rid of HIV and curing someone infected with it.

We know that provirus does not make virus until the cell containing it is 'activated'. This means the cell is turned on by coming across footprints of a germ which cause the T cell to make proteins getting the immune system ready to fight the invader. When the T cell is manufacturing these proteins it also starts making HIV.

No one knows exactly HOW long it takes before all latently infected cells are activated.

For this reason, most scientists, doctors and activists have been very skeptical about finding a cure for HIV. Finding a cure would require getting rid of all cells that contain provirus. Unfortunately, the HIV medications we currently use do not get rid of these latently infected cells.

The second theory suggests that with more powerful drugs we might eliminate all HIV from the body.

New drugs which are in the pipeline are much more powerful than the one's we have right now. This leads us to a hopeful possibility. What if we could eliminate virtually all infected cells with the help of brand new HIV medications that are more powerful than ever before? What if the new drugs work so well that the immune system is able to get rid of the few infected cells that are left? This is the operating theory behind radiation treatments for cancer.

How can we find out which theory is correct?

First we would use the powerful new HIV medications now available -- which perhaps can shut down all HIV replication completely and then see if the body clears HIV infection.

Then, after testing to make sure no virus or provirus can be found, we would then stop using the powerful drugs and see if the virus comes back.

Sounds interesting, doesn't it? This extraordinary experiment is actually taking place right now.

Why try this now?

First, because it has been discovered that in fact latently infected cells, containing provirus, do get eliminated from the body. It is not clear why or how, but the data shows that the body does in fact get rid of these latently infected cells (provirus).

Dr. Fauci at the National Institutes of Health, whom I mentioned above, is conducting this study. His group found that in seven HIV-positive people who used strong antivirals within 4 months of being infected with HIV, there was a reduction in the amount of provirus by 50% every 4.6 months. If these results hold up, the scientists estimate that 7.7 years of the combination therapy could possibly eliminate HIV.

The second reason this study is being done now is because there are new powerful drugs such as entry inhibitors and others, which can be used to shut down viral replication, perhaps completely. Perhaps elimination of HIV would then happen faster, maybe in one year.

The experiment is underway. Patients will be dosed with the powerful new antivirals to hopefully shut down replication altogether for one year, and then they will be taken off the medication -- assuming no virus can be found -- to see if the virus comes back.

This is an experiment that needs to be done, and it's fine to hope for good results. But there are good reasons to think it will not work, and we should not raise our expectations too high. Perhaps it will work in a few unusual people -- those who are diagnosed with HIV soon after they were infected and go to the doctor and get HIV medication. Clearly we are far away from understanding how this could work for the majority of people with HIV. Perhaps it will work for a limited period of time in some people, giving them a vacation from meds. Perhaps it will succeed completely and we can look forward to a cure.

The world will be waiting to hear the results.

Note, JSJ: This article was written before publication of laboratory research on an enzyme that can target HIV in the DNA of latently infected cells [3].

References

1. http://www.bloomberg.com/apps/news?pid=20601087&sid=a.0x1mlV37Qw&refer=home

2. http://www.thebody.com:80/content/news/art41026.html

3. Sarkar I, Hauber I, Hauber J, and Buchholz F. HIV-1 Proviral DNA Excision Using an Evolved Recombinase. Science. June 29, 2007; volume 316, number 5833, pages 1912-1915, http://dx.doi.org/10.1126/science.1141453

David Scondras is the founder of Search For A Cure. He developed the nationally recognized HIV treatment series, Reasons for Hope. All articles in the series are reviewed by expert HIV doctors & scientists as well as an HIV positive & negative focus group to ensure both accuracy and understandability. If you have any questions or would like to receive the Reasons for Hope series contact Search For A Cure at 617-945-5350 or e-mail at hope@sfac.org . Please visit our web site at http://www.searchforacure.org



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