Jay A. Levy, MD Comments On the Future of HIV/AIDS Research
Jay A. Levy, MD: Professor of Medicine, University of California, San Francisco
When AIDS was first recognized in the United States 20 years ago, no one expected to see the worldwide spread and devastating effects the virus has had on human populations. For researchers directing efforts at finding ways of controlling HIV infection, the challenge is to provide a solution that can be available for both industrialized and developing countries. One of the major promising approaches toward this objective is eliciting immunologic responses against HIV. This host reaction to the virus is the mechanism by which some individuals have survived this infection for over 20 years without the use of antiviral drugs. These long-term survivors have inherited a natural means for warding off HIV and preventing its destruction of the immune system. We need to discover the secret to this long-term survival and develop strategies for reproducing it in other infected people.
In particular, information on the proper functioning of both the innate (natural) and the adaptive immune response of HIV will be useful in finding new approaches for future therapies. The current highly active antiviral drugs are very effective in lowering the viral load and reversing the clinical symptoms of HIV infection. However, their long-term effect is limited and a restoration in immunologic responses to HIV has not been achieved. Combining the drugs with immune system activators such as viral protein immunizations and/or immune enhancing cytokines (such as IL-2) would appear to be the best future direction for long-term control of HIV infection. If the anti-HIV immune response can be restored, the potentially toxic antiviral drugs could be stopped or intermittently given. Our own laboratory is pursuing the identification of a novel anti-HIV protein produced by CD8+ cells. This CD8+ cell antiviral factor (CAF) blocks HIV after it enters the cell and prevents its production of progeny viruses. CAF production correlates with a long-term healthy state. Once its nature is known, CAF could be very helpful in therapeutic approaches to HIV infection.
Another topic meriting attention is the evolution of new HIV strains. With the inability to arrest the rapid spread of HIV in certain parts of the world, new types of HIV strains will be emerging. Many of these will represent genetic combinations of two or even three different viral types. These recombinant viruses could pose new problems for antiviral therapies and a vaccine. Recognition of these agents and approaches to control them should be another major emphasis in future research.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.