International AIDS specialists on Thursday released what they call a road map for research toward a cure for HIV — a strategy for global teams of scientists to explore a number of intriguing leads that just might, years from now, pan out.
"Today's the first step," said French Nobel laureate Francoise Barre-Sinoussi, co-discoverer of the HIV virus who also co-chaired development of the strategy.
"No one thinks it's going to be easy," added strategy co-chair Dr. Steven Deeks of the University of California, San Francisco. "Some don't think it's possible."
The announcement came just before the International AIDS Conference begins on Sunday, when more than 20,000 scientists, activists and policymakers gather in the nation's capital with a far different focus: how to dramatically cut the spread of the AIDS virus, what they call "turning the tide" of the epidemic, using some powerful tools already in hand.
Chief among them is getting more of the world's 34 million HIV-infected people on life-saving medications, so they stay healthier and are less likely to infect others. By itself, that is a huge hurdle. Just 8 million of the 15 million treatment-eligible patients in AIDS-ravaged poor regions of the world are getting the drugs.
But Barre-Sinoussi, president-elect of the International AIDS Society, which hosts the conference, said that lifelong treatment, as good as it is, isn't the end-all solution — and that science finally is showing that a cure "could be a realistic possibility."
The panelists refused to estimate Thursday how much this research would cost. But already, the National Institutes of Health has increased spending on cure-related research, about $56 million last year, according to a report in this week's issue of the journal Nature. Scientists attempting cure research will meet Friday and Saturday, ahead of the AIDS conference, to compare notes.
And the new strategy won praise from Michel Sidibe, executive director of UNAIDS, the Joint United Nations Program on HIV and AIDS.
"The previous generation fought for treatment," he said. "Our generation must fight for a cure."
Today's anti-HIV drugs can tamp down the virus to undetectable levels — but they don't eradicate it. Instead, tiny amounts of the virus can hide out in different tissues and roar back if medication is stopped.
That means there's no certainty of developing a cure.
"I'm not sure we can, but we're going to try," Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said in a recent interview. "This virus is uncanny in its ability to be able to integrate itself into a cell, as a reservoir, and no matter what we've done so far, we have not been able to eliminate that reservoir."
Yet one person in the world apparently has been cured: Timothy Ray Brown of San Francisco, who in 2006 was living in Berlin when in addition to his HIV, he got leukemia.
Brown underwent a blood stem cell transplant — what once was a bone marrow transplant — to treat the cancer. His own immune system was destroyed. And his German transplant surgeon found a donor who was among the 1 per cent of whites who have a gene mutation that makes them naturally resistant to HIV — their cells lack the specific doorway the virus uses to get inside.
It worked. Brown has been off HIV medications for five years and is doing well, Deeks said Thursday.
That dangerous and expensive transplant isn't a practical solution, but it has sparked a variety of research into other possible ways to eradicate HIV. Already, 12 early-stage studies involving small numbers of patients — fewer than 200 people worldwide — are under way, the international panel said Thursday. Results to see if any are promising enough to pursue should be out in the next year or two.
The priorities of the new cure research strategy:
—Determine why HIV hibernates and persists.
—Learn why some people are naturally resistant. In addition to that 1 per cent of people with the gene mutation, researchers now are studying a small group of patients in France who started medication soon after they were infected and many years later were able to stop the drugs without the virus rebounding.
—Develop and test strategies to make HIV patients more naturally resistant. Already gene therapy studies are under way to knock that HIV doorway out of people's own infection-fighting blood cells.
—Learn where all those secret reservoirs are.
—Develop strategies to attack the reservoirs. One new attempt uses drugs to wake up the dormant HIV so the immune system can spot and attack it, what Deeks called the "shock and kill approach." Last spring, University of North Carolina, Chapel Hill, researchers reported that a drug normally used for lymphoma made some latent HIV rapidly detectable in six patients. Deeks has a similar study under way using an old anti-alcoholism drug.
—Develop good tests to measure these tiny amounts of dormant HIV, crucial to telling if any cure attempts are promising short of taking patients off their regular medication.
International AIDS Conference: http://www.aids2012.org
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