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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.

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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