Live Chat: A New Push to Cure AIDS

[sam66]

 Live chat with Anthony Fauci ;  Steven Deeks ;  David Margolis

 
     Beginning in 1996, cocktails of anti-HIV drugs proved that they rescue people at death's door and stave off AIDS for decades. Despite initial hopes that the drugs might eradicate the virus from the body, it soon became clear that no one was cured because of stubborn reservoirs of cells infected with latent virus.

Today, an improved understanding of how HIV remains latent and new ideas about how to purge the reservoirs have led to the biggest push yet to cure people, including millions of new dollars being poured into the effort. And the field now knows that a cure is indeed possible because of an unusual stem cell transplant in one HIV-infected person with leukemia who no longer has any detectable virus in his body.



      Transcript of full discussion :   on  Science magazine

       http://news.sciencemag.org/sciencenow/2011/05/live-chata-new-push-to-cure-aids.html?etoc#chat




         3:01
   
   
[Comment From Courtney Courtney : ]
What do you think are the largest barriers to curing HIV? What do you see as the most promising approaches to a cure for HIV?
Thursday May 12, 2011 3:01 Courtney
3:01
   
   
Jon Cohen:
Welcome to the chat. Anthony Fauci, Steven Deeks and David Margolis are here with us. Please keep your questions focused on HIV cure-related research.
Thursday May 12, 2011 3:01 Jon Cohen
3:02
   
   
Jon Cohen:
The first question is from Courtney
Thursday May 12, 2011 3:02 Jon Cohen
3:02
   
   
Steven Deeks:
The major barrier to eradication is undoubtedly the presence of long-lived latently infected resting memory cells. Other barriers may exist, including other reservoirs (e.g., macrophages), lack of functional HIV-specific T cells and perhaps low-level viral replication, which is a focus of ongoing intense investigation and controversial.
Thursday May 12, 2011 3:02 Steven Deeks
3:03
   
   
David Margolis MD:
As many have said the largest barriers to cure are continued viral expression and persistent viral genomes that are not being expressed, but can reignite infection if ART is stopped. It may be that approaches that purge or destroy reservoirs may eliminate low-level viral expression, but more likely combined approaches using both drugs and the immune system are needed.
Thursday May 12, 2011 3:03 David Margolis MD
3:04
   
   
[Comment From Kate Krauss Kate Krauss : ]
Assays: The development and standardization of assays to measure reductions in HIV viral reservoirs is critical in the development of a cure. How can we make sure assays are identified and standardized as quickly as possible? Treatment advocates are watching this issue carefully. Second question: Can the NIH commit to funding this?
Thursday May 12, 2011 3:04 Kate Krauss
3:06
   
   
Dr. Anthony Fauci:
The NIH is committed to funding any proposal that has scientific merit and passes peer review. Developing a standardized assay to measure reductions in HIV viral reservoir is an important issue and we are hopeful that we will receive excellent proposals.
Thursday May 12, 2011 3:06 Dr. Anthony Fauci
3:08
   
   
Steven Deeks:
I agree with Kate's perspective that one of the most important issues to address soon is how to quantify the size of the reservoir during therapy. There are many possible approaches, including measuring HIV RNA and DNA levels in plasma, cells and tissues. The problem is that we have no "gold-standard" to allow us to define which assay works the best. We may eventually be able to define the relationship between measures of viral load and risk of subsquent rebound during an interruption, but such studies are probably not going to happen until the we understand the characteristics of the current assays. There are a number of correlative studies now being planned.

       http://news.sciencemag.org/sciencenow/2011/05/live-chata-new-push-to-cure-aids.html?etoc#chat

[sam66]

   DR Anthony Fauci's thoughts are interesting, considering he is one of the more cautious people when
   it comes to new treatment strategies .

   "Dr. Anthony Fauci:
Thanks for the question, Stephen. The major roadblocks to an HIV cure trial are the lack at this point of very good ideas with feasibility to implement. We are at the stage of trying to define mechanisms of persistence of reservoirs and how we might theroetically (and ultimately pratically) eliminate them. When we get this information, we can implement an appropriate clinical trial. My goals for HIV cure research in the short term (2011) is to pursue the arena of therapeutic vaccine trials to suppress virus rebound in the face of discontinuing of therapy. In the longer run (2012 and beyond), we are looking at developing and testing new classes of drugs that can eliminate reservoirs. Modified stem cells research is also a priority.


   Dr. Anthony Fauci:
Stephen, you may not be aware that the NIH supported John Zaia and Sangamo in their initial work that led to the development of the zinc finger nuclease. Stay tuned. You will be hearing further news soon about the funding of these types of studies.


    Dr. Anthony Fauci:
Significant progress will be development of strategies to keep people off of ART for longer and longer periods of time. This may be possible within 3 to 5 years."

[jeezx]

i get mixed signals from this log.

David Margolis MD:
 I will go out on a limb and say that in 10 years there will be functional cures (no disease without therapy) in some people, but it will take longer than that to get to broadly applicable eradication therapy.

10 years at least for a functional cure?
Science does not have much knowledge about the reservoirs.

I get the feeling we are not progressing quite as fast as i thought we were towards a cure..

bummer............ 

[sensual1973]

the word 10 years depresses me.

[LM]

If it comes indeed in 10 years, that is great news. Some people have been waiting for 30 years, let's not forget that. Of course I hope it comes earlier than that, after all, science may always surprise us.

[mdh26]

If you're saying that the words 10 years depresses you because that's what they've been saying since the 90s . . that makes since.

Actually getting a cure in 10 years though would be fantastic. And the number of different ways that look like legitimate avenues to a cure on the horizon defiinitely gives me hope.

[jeezx]

mdh26,

they are not talking about a complete cure in 10 years. in other words no complete eradication in the next 10 years.
'functional cure' means you still carry the virus, but wont need meds, and that is AT LEAST in 10 years time..

reading this from almost a year ago (July,2010) :

renowned HIV researcher Sharon Lewin said she believes a cure for the disease will be found within five or 10 years.

Code: [Select]

http://www.smh.com.au/national/optimism-on-aids-cure-before-2020-20100718-10g3m.html
makes me think if she also meant a functional cure just not clearly saying that.

I also read an article about german scientists saying in 2008 that a cure will be here at worst by 2018 (meaning 10 years from 2008).

but as to date, 2011, we are still '10 years away from a cure'. why are we always 10 years away? why not 5? at least make us happier for the short term.

im not against scientists i think they are doing an excellent job.
you know how is the feeling inside...

[metekrop]

Interesting discussion.  But, yes, why they always say 10 years. 

It is high time now and let me run to the pharmacy and pick up my meds.

[J220]

I take any predictions with a grain of salt. They are after alll just words. The truth is no one knows when a cure (fucntional or complete) will happen. Could be 1 year, 10 years, 20 years. No one knows, regardless of credentials. Until then, I live life to the fullest, and I choose to be optimistic that the next discovery could be the big one. Onward!

[georgep77]

I take any predictions with a grain of salt. They are after alll just words. The truth is no one knows when a cure (fucntional or complete) will happen. Could be 1 year, 10 years, 20 years. No one knows, regardless of credentials. Until then, I live life to the fullest, and I choose to be optimistic that the next discovery could be the big one. Onward!

I completely agree with you J220
                             

[geobee]

Here's an article predicting the imminent demise of Magic Johnson -- from 1991. 

http://news.google.com/newspapers?id=_N0yAAAAIBAJ&sjid=tn0DAAAAIBAJ&pg=1663,2125127&dq=aids+cure&hl=en

And two more in a similar vein to the chat conversation.

http://www.ebar.com/news/article.php?sec=news&article=5743
http://seattletimes.nwsource.com/html/health/2015223960_apusmedaidsanniversary.html

The Seattle Times reporter interviews Tim Brown's mother -- she has interesting details re: the decision to go for the stem cell transplant. Also, interesting were Dr. Lalezari's and Fauci's comments re: gene therapy.