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The Search for the Cure Heats Up! Part Two


Renewed Urgency in the Search for a Cure

By Bob Frascino, M.D.

February 9, 2011

There are a number of reasons the search for a cure for HIV has been not only reawakened, but also reinvigorated. These include:

1. There is now very sound and growing evidence that we cannot "treat our way out of this epidemic," as philanthropist Bill Gates stated at last summer's International AIDS Conference in Vienna. Even with improved access to testing and treatment, for every individual who starts antiretroviral therapy (ART), two additional people become newly infected with the virus, according to the UNAIDS report.

2. Even though lifetime treatment with potent combination antiretroviral therapy may be effective in preventing disease progression to end-stage AIDS and death, the therapies are expensive and are associated with significant side effects and toxicities.

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3. Due to the global financial crisis, many developed countries are reneging on their earlier commitments and pledges to fund long-term ART for the millions of infected people in Africa and other parts of the developing world. Even in the United States the waiting lists for states' AIDS Drug Assistance Programs (ADAP) are growing as budget deficits continue to skyrocket. ADAP provides ART to those who cannot afford the life-sustaining treatment.

4. Scientific data now strongly suggest that HIVers, even after the virus has been suppressed to undetectable levels with ART, are experiencing damaging immune inflammation. (See my blog on this topic: HIV Causes Accelerated Aging: Has AIDS Become Acquired Inflammation Disease Syndrome?). Immune inflammation is now felt to be the cause of premature aging in HIVers, which results in cardiovascular and cerebrovascular disease (heart attacks and strokes, respectively), kidney problems, bone problems, diabetes and cognitive dysfunction.

5. Despite 25 years of research, vaccine development has produced little but frustration. Countless HIV vaccine candidates have failed in clinical trials in the early stages of testing. Merck's V520 vaccine was actually associated with an apparent increase in risk of infection (STEP trial). More recently a combination vaccine trial in Thailand did not live up to the hype surrounding the trial when it began in 2009. Vaccine research has received astronomically more research money than has research devoted to cure. Public health experts and HIV research scientists now believe it's time for a fresh look at discovering a long-term solution to HIV, i.e. cure!

6. The "Berlin Patient" story has piqued interest in the possibility of cure. I discussed this case in detail in a recent post in the expert forum.

7. A combination of treatments may produce ART-free remission, a so-called "functional cure." The concept is to disable the virus and/or strengthen the immune system enough to hold the disease in check when HIVers discontinue ART. An increasing number of experts, including yours truly, now believes this goal is achievable in the foreseeable future.

Stay tuned for part three of this blog. I'll review the current cure research strategies, including flushing the virus out of resting CD4 cells, gene therapy and some immune-based strategies.

Want to get in touch with Dr. Bob? You can reach him through his "Ask the Experts" forum, by sending a message to the Robert James Frascino AIDS Foundation, or by leaving a comment for him below. (If it's a private message, or if it includes personal info such as your e-mail address or phone number, we won't post the comment, but we will send it along to him.)

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See Also
The Search for the Cure Heats Up! Part One
The Search for the Cure Heats Up! Part Three
Eliminating HIV/AIDS: How We'll Get to Zero
Can HIV Infection Be Cured?
More Research on a Cure for HIV/AIDS

Reader Comments:

Comment by: Anonymous (New York) Tue., Mar. 15, 2011 at 12:52 am EDT
I'm having trouble seeing the value in point 7 in light of point 4. Sure, a boosted immune system providing a "functional cure" (conversion to long-term nonprogressor) is better than enduring meds to get the same result, but inflammation is still a long-term danger either way. So what does 7 offer other than a respite from meds. A "functional cure" isn't a cure. Inflammation persists as long as virus persists, doesn't it?
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Comment by: Pete (United Kingdom) Sun., Feb. 27, 2011 at 9:28 am EST
If I believed in supernatural beings in the sky, Bob, I would say, "Bless you!". But I don't, so for the objective listed information above, I can only say Thank You and that I look forward to your further postings, as and when.

Thank you.
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Comment by: Name Withheld (Los Angeles) Sat., Feb. 26, 2011 at 4:35 pm EST
Dr Bob:
Please include Perifosine (and like agents) in your discussion for your part III article. Almost nothing is written about these agents.
Do you have any opinions on the likelihood of a human trial using a triple combo of agents to
1. flush out HIV
2. kill latently infected HIV cells (like Perifosine)
3. immune system activators (like IL7).
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Comment by: Zak (philadelphia, PA) Mon., Feb. 21, 2011 at 3:00 pm EST
Dear Bob,
I'm a psychotherapist working with HIV + clients.

Re HIV cure, i read the very interesting article in this edition of Body.com that continues the novel ideal of making the HIV mutate itself to death. The drug is KP-1461 by Koronis. the article is athttp://www.thebody.com/content/art60320.html.

I'd be interested in your take on this approach. thanks.

Zak
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Comment by: Dave (Pa) Mon., Feb. 21, 2011 at 12:44 pm EST
The (toxic) side effects of the HAART drugs include: profuse diarrhea, lipidemia, lipoatrophy,lipdytrophy, fatique, diabetes just to name a few. People are in denial if they think these drugs don't have terrible side effects. What is more distressing is when patients and PHYSCIAN'S minimize their existence. Why has Egrifta been approved by the FDA? Further, in terms about a "cure" functional or otherwise, how long have we been hearing about it with no evidence in sight! The "Berlin patient" said by some to be "cured" even raises doubts by respected clinicians such as Dr. Fauci! If on reads Dr. Bob's posts they are merely saying in blog 1, that HIV has got to go. In blog 2 the only mention of a "cure related" claim is that latent cells have to be flushed out by the likes of IL-2. So gang, there is perhaps different hypotheses that are being floated about, but a cure, not yet. Sorry to rain on any parade and I so hope that I am totally wrong, but the evidence is just not there. Let us remember that Mr. Clinton expected a cure "within 10 years," well we are overdue by about 6-7 years for that claim.
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Comment by: Laughing Out Loud (Salem) Sat., Feb. 26, 2011 at 6:41 pm EST
Oh you're right, we should abandon this cure nonsense and rededicate ourselves 110% to something more viable, like a vaccine. Because that's where the real progress has been made, hasn't it? If you can't tell, I'm being sarcastic.

And regarding Faucci, don't get me started. Thats a bit like asking Judas about the divinity of Christ.
Comment by: ethanwilson (nashville, tn.) Wed., Mar. 16, 2011 at 11:37 pm EDT
I understand what Dave is saying here. But I really think that we should be optimistic. We could finally be onto something now. i just hope we are,we need a cure so badly.


Comment by: John Eisenhans (St. Louis, MO) Thu., Feb. 17, 2011 at 5:06 pm EST
More reasons to be hopeful:
1. Effective virus suppression by ARV meds dramatically reduces the chances of passing HIV to another person. The possibility exists that the right combination of drugs could render people who take their meds as directed non-contagious.
2. Pre- and post-exposure prophylaxis works. By taking ARV meds as directed, it may be possible to prevent infection even more effectively with medication than with condom use. Together, the two (meds + condoms) could reduce the risk of infection to near zero.

These two developments show that it is now already possible (in theory at least) to end the epidemic today. If everyone who is HIV+ had adequate access to ARV meds and everyone at risk for becoming HIV+ had access to prophylactic medication right now, the last new HIV infection would have occurred a moment ago. It is now a problem, not of science, but of politics and economics. If those who hold the power really wanted the epidemic to be over, it could be. That is not the same as a cure - those of us who are already infected would remain so. But it is a leap forward, toward the end of the epidemic, that no decent, rational person would not want. And yet nothing has changed. The fact is that HIV is much too useful to those who make their living and even their fortunes from it, and to those who want an end, not to the epidemic, but to behavior of which they do not approve. It is up to us to demand the means to the end of HIV.
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Comment by: D (VA) Fri., Feb. 18, 2011 at 2:18 am EST
So very true John!
Comment by: Ben (Des Moines) Mon., Feb. 21, 2011 at 10:26 am EST
I fail to see how this is relevant to the millions already infected.
Comment by: ethanwilson (nashville, tn.) Wed., Mar. 16, 2011 at 11:29 pm EDT
Don't forget those infected. I'm hiv poz and I really want a cure. I want a cure so badly,everyone who is positive really wants this.


Comment by: Anonymous (South africa) Wed., Feb. 16, 2011 at 12:09 pm EST
Let me tell you something people who are hiv negative think that they are so special and free from dying wich is wrong .you can go everywhere caring a condom but find yourself positive i thought i was safe but i was wrong just find the cure before the world perishes
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Comment by: Misled (The Real World) Fri., Feb. 18, 2011 at 12:30 am EST
Ditto. As a former "condom nazi" and current pozitoid, it takes everything I have to not scream when I hear poz and neg alike babble sanctimoniously about condom usage.


Comment by: So tired of it all... (London, UK) Tue., Feb. 15, 2011 at 3:16 pm EST
@ J. I too hear similar stories. The misinformation is phenomonal. You would think that with the rise of the internet (it has revolutionised the world at roughly the same time as HIV/AIDS has damaged it), that more clear accurate information would be available.

Sadly, it seems to be the opposite. People don't seem to want accurate clinical info. They want word-of-mouth gossip and stories from their peers. This is why there are so many chat rooms. Personally, I think chat rooms must be breeding grounds for the misinformation that is spread so quickly and held to be true.

I think it might be a good idea if more HIV professionals went into chat rooms, and in a friendly, helpful, cheerful manner gave up-to-date info, especially to impressionable young gay men who want lots and lots and lots of sex, but none of the responsibility that goes with it. It's just a thought...
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Comment by: Parth Rana (India) Tue., Feb. 15, 2011 at 12:26 am EST
Oh Dr. B. you always get my hopes up!
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Comment by: Anna (London) Sat., Feb. 12, 2011 at 7:28 am EST
Thanks doc can't wait for part 3.. There needs to be a cure for HIV.. Terrible diseases
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Comment by: idahomo (Idaho) Fri., Feb. 11, 2011 at 6:00 pm EST
I'm really curious about point 7 that was made in this post concerning ART-free remission, but it didn't contain any citation links. Is there any place I can find more information on this possibility/research?
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Comment by: cyber scott (USA) Thu., Feb. 10, 2011 at 10:22 am EST
Zak,

He is a patient, read his BIO before you bash a great post and amazing doctor.

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Comment by: J. (Philadelphia, PA) Thu., Feb. 10, 2011 at 1:18 am EST
I hope they do find an actual cure for HIV.

I'm in my mid 20s and I hear tons of men and women my age who are of all sexual orientations who think that there's an actual cure for HIV or that the highly expensive medications with not so fun side effects are a cure and that the meds are somehow like taking a daily Vitamin.

Then these same people of all genders/orientations have told me how they don't get tested, they don't have safer sex, and they don't have their partners get tested multiple times before they stop using condoms for anal or vaginal sex.
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Comment by: zak (zak@hotmail.com) Wed., Feb. 9, 2011 at 11:23 am EST
here we go again! more news on a cure!the best they have come up with are toxic drugs that eventually kill the hiv patient...who said this is a manageable condition? speak to the patients!!........we have to except that there will never be a cure for this 'plague'..we need to educate people about abstinence and the perils of unsafe sex..hard hitting campaigns are now in order...the liberal elite have suffocated all sensible discussion on 'promiscuity' and free love...maybe we need someone to go into a AIDS ward and see what is still happening...people are still dying!
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Replies to this comment:
Comment by: Ted (Louisville) Thu., Feb. 10, 2011 at 2:04 am EST
Zak, I would agree that I don't want HIV docs and experts blowing smoke up our asses just to make us feel better. I sometimes wonder whether they are doing that when they say we should live an almost normal lifespan with effective therapy. However, Dr. Bob has just recently become optimistic about some kind of cure, from following his forum. I don't think he has come to this conclusion without much thought. We'll have to wait and see his reasons. And, he gives out safe sex advice everyday and education on how to stay negative.

Now about the "toxic meds killing the hiv patient", I would be interested to hear more on what you're talking about. Yes, HIV meds can be toxic to some. However, I talk to so many people who've been poz for 20, 25, and even 30 years who are alive because of those meds. Some have health issues, some don't. The ones who do often say they blame HIV itself and the earlier meds. Most don't blame the newer ones. I know it happens--kidney issues with Truvada, for example, but I believe that is rare and usually only happens with people with pre-existing kidney issues, right?

And, I'm not sure what you mean by "the liberal elite and promiscuity." I'm a liberal, not so elite, and I tell my friends to wrap it up. I'm a member of an HIV forum where most are liberal. Most there discuss not tricking with just anybody and to always wear a condom. The conservative elites are just as promiscuous. You can have sex with just one person and get HIV. It is about protecting yourself no matter if you have 1,000 partners. Obviously reducing the number of partners would reduce the chances of getting infected--but not if you don't practice safe sex with that one person. So, let's see what Dr. Bob has to say about the new research that has made him more optimistic.
Comment by: Ben (Portland, OR) Sat., Feb. 12, 2011 at 3:10 pm EST
Zak, what is with you people's crazy relationship with this virus? Do you want people to see "aids wards" because you think their long term behavior can be changed with embellishments, or do you just get a sick thrill from the parade of horrors that is untreated HIV? An AIDS ward is irrelevant to people with access to HAART. Talk about what the virus will do to them TODAY, in Paris or Peoria. Stop scaring them with pictures from Harare or Houston, circa 1987. As for "there will never be a cure", how can you even say that with a straight face? Anytime ANYONE starts using phrases like "never" and "impossible" when making predictions about the future, we should realize that they're talking about things they can't know and immediately begin questioning their motivation.

Dr. Bob, you're an inspiration to me and a lot of others who are "positively charged". I'm a little taken aback by your change in expectations though. Nothing that you've cited has changed from when you last told us that you weren't so optimistic about a cure. Is there anything in the direction of research that you find truly inspirational? And what can we do to agitate for a cure?


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Bob Frascino, M.D., was President and Founder of The Robert James Frascino AIDS Foundation. He had been an outspoken, popular expert in TheBody.com's "Ask the Experts" forums on safe sex and fatigue/anemia since 2000. Once a Fellow of the American Academy of Allergy, Asthma, and Immunology, and the American Academy of Pediatrics, Dr. Frascino served as Associate Clinical Professor of Medicine, Division of Immunology, Rheumatology, and Allergy, at Stanford University Medical Center from 1983 until 2001. He was a member of the American Academy of HIV Medicine and had also been a distinguished member of the executive boards of numerous state and regional associations.

We're inexpressibly saddened to share the news that Dr. Frascino passed away unexpectedly on Saturday, Sept. 17, 2011. Click here to read more and to share your thoughts.


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