"A cure is possible." These words are scrawled in red on a grease board in my office at Project Inform to remind me and anyone else who walks by that a cure for AIDS is not entirely out of the question. There was a time I wouldn't have thought a cure would ever be possible or that I would survive to see it. But in the last few years researchers have been quietly studying various pathways towards a cure that are now getting more attention. We are only just touching the surface in understanding eradication or "drug-free" remission of HIV and most likely it will require a combination of biological and chemical strategies. But new federal and non-profit funding is also being offered in the area of cure research, still a long way from what is needed, but a good start.
I am one of the lucky survivors who has benefited from the great success with HIV care and treatment over the past 25 years. But current treatments will not be the answer for everyone and certainly won't be sustainable as the world scales up access. Drug resistance, long-term side effects, and adherence will continue to be challenges to a lifetime of taking medications.
Scientifically, curing HIV has long been elusive, as scientists have tried to crack the complexity of a "shape-shifter" virus and an enigmatic immune system. In 1996, when combination antiretroviral therapy was found to be effective in bringing the virus to undetectable levels, it was proposed that HIV could be eradicated. It was later deemed by a majority of researchers that complete eradication was impossible. Since then, any mention of a cure was defensively disputed by scientists and activists alike. Virtually the only time you would see mention of an AIDS cure was from snake oil salesmen on the Internet.
Until recently, the challenge of stopping HIV transmission through preventative vaccines or a microbicide has failed to live up to the expense and effort that went into it, even though there is new evidence that shows these strategies may be at least partially effective. But it wasn't until the news of the Berlin "cure" patient surfaced that people began to open their minds to the possibility of actually curing HIV. This was the extraordinary case of an HIV-positive man living with leukemia who received a bone marrow transplant with CD4 cells that lacked CCR5 and was later found to be free of HIV. The news unleashed a wave of intense interest among researchers.
But one "cure" does not mean a worldwide cure. This case was certainly unusual and most would agree it will be nearly impossible to reproduce. There are many scientific, strategic, and funding barriers to address before we can claim victory against HIV.
At least one company has developed a technology now in clinical trials to try and mimic the Berlin cure. This is where I come in. I volunteered for a pilot study to look at this new technology that uses zinc fingers, tiny molecular scissors that snip the CCR5 gene off my DNA in CD4 cells that are removed from my body and then expanded. These manipulated cells will be infused back into my body, and this early study will look to see if they survive and for how long. Eventually, if this procedure works, many more people will be studied to see if virus levels decrease when they go off antiretroviral drugs. Then confirmation studies will proceed.
I have been down this road before with a thymus transplant study in 1987, desperately seeking a biological fix to my weakened immune system. Back then I was fighting to stay alive. This time, I'm fighting for a cure.
This may seem like a far-fetched idea, but research and technologies like this will collectively provide more answers through laboratory and clinical trials. Today, drugs are being studied that help activate sleeping cells that are holding HIV inside. Once the virus is purged from these activated cells, current regimens will kill any remaining virus in the plasma. Therapeutic vaccines are being explored to restore lost immunity in those who have been living with HIV.
So, I am excited about the prospects, even if it is early and even if there are still skeptics who doubt a cure for HIV can ever happen. Consider the beginning of HIV when discoveries were made in understanding the HIV lifecycle, an incredible breakthrough in a span of two decades that led us to where we are today. Discoveries of this kind occur rarely; more often there are steps backward, but we are clearly on the right track.
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