Dr. Young, Since last year I hear a lot of "functional cure" and "cure" for hiv. It is a big progress to talk about cure considering how many people die without getting a medication to fight this evil. My question is now when do you think we will have either functional or definite cure?
Hello thanks for posting.
The words functional cure and cure for getting a lot of attention these days. Let me start first by addressing HIV cure. I believe that we know have evidence for me limited number of cases that HIV cure is indeed possible. This is a remarkable statement.
First, we learn through the medical journeys of Timothy Brown (the Berlin patient) that following bone marrow transplantation with genetically selected donor cells that eradication of HIV as possible. This is not a generalizable approach given the risks bone marrow transplants, but just a way forward.
Second, we know how convincing evidence that HIV-infected infants maybe cured by the early initiation of triple drug therapy (scan our pages for stories of the Mississippi baby). The prospect of implementation of these new scientific findings is exciting as over 2000 babies are born HIV-infected every day and if we can deliver treatment to these infants it's possible to prevent lifelong HIV infection.
With regard to functional cure, much depends on how one defines this term. At a minimum, we now live in a time when a single well-tolerated pill prevents disease progression of death from AIDS. Some would argue with me on this, I think of this as a functional cure. Not a cure for HIV but rather that you're from death from AIDS. We are also on the doorstep of very long acting injectable medicationsperhaps an injection monthly or every other month. These are not curative medications of course, but could minimize the daily impact of HIV or its medications. Others are working on strategies that could train the body to fight off HIV without the need of medications. We learned of exciting results of early-stage genetic strategies just this year. One concern however is that even with virologic control that there maybe ongoing problems with inflammationand long-term inflammation may lead to other complications such as cardiovascular disease and osteoporosis.
So overall, there is still much to learn and much research to be done. The near-term horizon offers great promise particularly for HIV-infected infants. Advances in treatment and possible cure of infants should not be seen as irrelevant for adults but rather as the populations of people where we may learn the most about how to cure others.
Ask again for posting and stay tuned. BY