Experts Debate: Is HIV Cure "Hype or Hope"?
Returning to the "defence," Giuseppe Pantaleo of Centre Hospitalier Universitaire Vaudois in Lausanne countered that we should not feel too depressed as "there is a lot to be optimistic about."
Pantaleo outlined the important proof-of-concept cases, previously reported on aidsmap.com, that indicate that a cure is possible at least in principle. These include the Berlin patient who was cured after a bone marrow stem cell transplant for leukaemia, an American baby who shows no evidence of remaining virus after starting ART within a day after birth; two Boston stem cell transplant patients with sustained viral suppression after antiretroviral interrup-tion; and the French VISCONTI cohort of individuals who appear HIV-free after ART initiation during acute infection.
Pantaleo argued that continuing residual viral replication despite ART is "probably responsible" for replenishment of latent reservoirs and better antiretroviral drugs that fully suppress replication may offer hope for a functional cure. Data on this point are mixed, however, and some researchers think that at least current classes of antiretrovirals already provide maximum suppression.
Summing up, Pantaleo noted that only 25% of people with HIV in the US have achieved undetectable viral load on ART and that even excellent current therapy remains "very hard to take" especially over the long term.
A combination of strategies will be the secret of an HIV cure, he concluded. "We're just at the beginning," he said. "A functional cure is possible if there is the right investment in these new approaches."
Perno added that there is "clear evidence that persistent virus is harmful." Even if 'undetectable', the virus is not absent in the body and even a few copies may be detrimental, for example by maintaining a state of persistent immune activation. "In the long term we will pay a price or this," he cautioned.
But the effectiveness of modern antiretroviral treatment was the gist of Georg Behrens argument against pursuing a cure. Behrens, of Hannover Medical School, explained that current ART is so good that attempts to cure HIV are not worth the risk. Donor stem cell transplants, for example, can be fatal and are only appropriate for people with life-threatening conditions such as leukaemia or lymphoma.
Furthermore, better antiretrovirals are in the works including agents that target HIV attachment and maturation, the "very ends of the replication cycle." Treatment dramatically ex-tends survival of people with HIV and the relatively small percentage who do not do well on current ART -- due to co-morbidities or adherence problems, for example -- are "not the best candidates" for risky cure approaches.
Behrens concluded that research should focus on improving ART for the broad population of people with HIV, not on curing a few exceptional patients. "We should ask not only is a cure possible, but what is the real benefit for patients," he said. "We may be able to fly to the moon, but that doesn't solve our problems with traffic here [on earth]."
After hearing the arguments on both sides the audience 'jury' rendered its verdict. Among the more than 100 participants, opinion was nearly evenly divided as to whether a cure for HIV is an achievable and worthwhile goal.
This article was provided by Being Alive. It is a part of the publication Being Alive Newsletter. Visit Being Alive's website to find out more about their activities, publications and services.
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