Nearly 30 years and 30 million lives later, scientists on Thursday announced the most comprehensive global strategy to find a cure for AIDS since the disease was first identified. The International AIDS Society (IAS) strategy, released ahead of the International AIDS Conference beginning July 22 in Washington, outlines seven key research areas and suggests a collaboration between funders, scientists, drug companies and patients.
"The field over the past 15 years has focused on trying to come up with optimal ways to control the virus," said Steven Deeks, co-chair of the IAS Scientific Working Group on HIV Cure at a press conference Thursday. "Now that we've come up with the drugs we're seeing some limitations," Deeks said. "The field has begun to shift towards finding an optimal intervention."
Advances in antiretroviral drugs have greatly improved the life spans of AIDS patients and reduced the rate of transmission by up to 96 per cent, according to studies. Still, Deeks said AIDS patients often find it difficult to adhere to the treatment's strict drug regimen, which must be taken every day for the rest their lives. The drugs are expensive and often toxic.
Moreover, according to the IAS, 46 percent of those with a medical need world-wide are not receiving the drugs. "All of us are mindful that if we do something really high-tech, will this be available to people in low-income countries?" said Sharon Lewin, an HIV/AIDS researcher at Monash University in Melbourne, Australia.
The strategy's multifaceted approach includes gene therapy, optimisation of current anti-AIDS drugs, therapeutic vaccination, immune-based therapy, and further study of small populations naturally resistant to the virus. Gene therapy caught the attention of the AIDS community after the virus was apparently eliminated in a San Francisco man after he received a bone-marrow transplant containing an AIDS-immune gene. Such an approach, however, is costly and difficult.
"I don't think anyone would want to go through what he went through to achieve that cure," Deeks said. The IAS strategy calls for collaboration from the "bottom up," beginning with patients who understand the risks of clinical trials, which can include toxic drugs and require extended pauses in order to judge if the virus has been eliminated.
Scientists around the world must work together instead of individually, said Francoise Barre-Sinoussi, co-discoverer of HIV and president-elect of the IAS. She said the group is working to create an inventory of different approaches, technology and results from different scientists. The group is also looking to standardise the way patients are tested to determine whether the virus has been eliminated. Even after extensive treatment, the virus remains in pockets of tissue and can be difficult to measure accurately.
The panel warned that finding a cure could be a long process. "We need to let the Obamas and the Merkels and the scientists know that this is going to be a long, difficult process littered with failures," said Mark Harrington, executive director of the Treatment Action Group.
He and other panellists refused to provide a cost estimate for the effort, saying nobody knows how long it will take or how much it will cost. "We don't want to put a price tag on it because we don't want to over-promise and then under-deliver," said Rowena Johnston, vice president of research at the American Foundation for AIDS Research. The IAS group was careful overall to temper optimism with reminders about the scientific process. "The field needs to realize that some of the stuff we're gonna try will work, but most of it will not," Deeks said.
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