May 7, 2013
Contrary to some hysterically hyped headlines this past week, HIV is not on the verge of being cured in the next three months, nor have scientists found an effective vaccine. The truth is that a hopeful compound to force HIV out of hiding is under study, and the results should be known in the near future. Unfortunately, however, even if researchers hit a home run with this drug, it won't likely be a cure by itself and we will still be waiting for the day that we have a vaccine or other types of immune therapy to help the body kill any remaining infected cells.
Let's unpack the hype. Last week the London Daily Telegraph ran a story on this new compound, but claimed that a cure was just around the corner. The reporter apparently misquoted the researcher and overly hyped what he'd been told. The reporter has since toned down his piece and changed the headline due to pressure from a prominent activist in England and likely due in part to a piece the researchers themselves felt compelled to post to refute the article's claims. Unfortunately, the press outside of London grabbed hold and has been retreading the original uncorrected story since then.
Here is the real story. First, contrary to some reports there is no actual vaccine involved at this point. That's probably the most mystifying and frustrating thing. Instead, there is a class of drugs that helps cause HIV that is bound up inside the DNA of resting immune cells to begin reproducing. If we want to cure HIV, then that's the first thing we'll have to do -- to unmask the hidden HIV. The class of drugs is called HDAC inhibitors.
Thus far, there have been four studies of this class of drug. Two were conducted with a very weak form called valproic acid that ultimately had no effect. Two more recent studies were with a drug called vorinostat and showed at least transient increases in HIV RNA production from latent cells, indicating activity, but the effect was also somewhat weak and didn't have the ultimate effect we'd want to see, which is to reduce the amount of HIV DNA there. That would tell us that we are actually reducing the size of the HIV reservoir.
The researchers in Denmark are using a more potent HDAC inhibitor called panobinostat. All of us in the cure advocacy arena have good hopes about the drug, but it is a very, very long way from being a cure all by itself and the very small Phase I study being run by the Danish researchers has yet to publicly report any results. Panobinostat may turn out to be a potent way to kick start HIV replication, but we'll probably have to pair it with a vaccine in order to kill those latent cells that panobinostat has woken up. Unfortunately, we're quite a ways away from having such a vaccine.
It says something quite sad about the state of science journalism in general that articles like this make it out the door. The hype that never pans out ultimately makes people so skeptical about the kind of work Project Inform advocates for and reports on. It's also sadly the case that stories like this, where the reporter, or the researcher -- or both -- hypes a study and claims a cure is just around the corner are all too common. We'll do our best to set the record straight when these arise.