For years, scientists have been working on cures for the fatal human immunodeficiency virus (HIV). Although there are medication treatments available, most popularly Biktarvy, once someone is infected with HIV, they have to take daily medication which suppresses the virus so much that the virus does not appear on blood tests. Taking HIV antiretrovirals turns the disease “into a chronic but manageable condition.” However, if someone infected with HIV stops taking their medication, HIV would re-arise and their immune system would no longer be able to protect itself from the virus.
HIV, transmitted from sharing needles and unprotected sexual activity, among others, infects 4,000 people daily. In 2021 alone, 650,000 people globally died of AIDS-related illnesses. Not only is treatment costly (lifetime cost of medical HIV care is more than $420,285), but “those in treatment for HIV can expect to live nearly 10 years fewer without major health conditions.”
HIV is a virus that affects cells’ genomes and either forces virus reproduction or lays dormant in the cell. Latent viruses can reactivate at any point and produce more HIV. However, because it tends to lay dormant after infection in addition to when medication is being taken, a cure for HIV will be difficult to find. What we do know, however, is that HIV infects immune cells called CD4, or helper T cells. Medication interferes with the reproduction processes of these cells but unfortunately cannot remove the virus when its DNA has already embedded itself into cells. Infectious disease doctor at Montefiore and an associate professor of medicine at Albert Einstein Medical School Dr. Robert Grossberg believes that the ultimate goal for HIV treatment is to “activate dormant HIV and kill it with medication.”
On Sunday, January 15, I had a conversation with Dr. Grossberg about HIV. Dr. Grossberg has previously appeared in the Fieldston News in articles about COVID-19 vaccines and the monkeypox epidemic. Although Dr. Grossberg is hopeful, he stressed that the future for an HIV cure seems pretty far off. Over 30 years of research have transformed the fatal illness into an effectively treatable one. Although everyone hopes a cure will be found soon, it may be more effective to focus on improving current treatments and making them more widely accessible. Dr. Grossberg emphasized that like any illness, “HIV has become a disease driven mostly by social determinants.” If we want to make things better for people with HIV, we should focus on providing stronger resources to communities that lack education and treatment programs.
However, current HIV medication may have long-term effects damaging the body, so researchers are trying to figure out other solutions to help those with HIV. In addition to the improvement of medications, scientists have also been trying to find HIV vaccines. For 40 years, there has been talk of discovering a vaccination, but as Dr. Grossberg pointed out, due to the structure of the virus and how it lays dormant in our bodies, an effective vaccine may never be uncovered. Unlike for COVID-19, HIV antibodies do not protect people avoid severe illness. With that said, scientists have been searching for a therapeutic vaccine. The goal of therapeutic vaccines is for infected people to have other ways to make the infection manageable without having to take medication. Most people with HIV take a pill every day, therapeutic vaccinations would assist “immune systems enough to fight the virus without medication.” Although there are no current HIV vaccinations and may not be for years, there are clinical trials for possible cures around the world.
Since 2009, there have been a few clinical trials that appear to have cured HIV patients who also have leukemia or lymphoma. In fact, there have been at least five cases where it seems as though both the HIV and cancerous viruses have been cured. Like these cancers, HIV attacks blood cells or blood-cell forming systems. Scientists have wiped out and replaced blood-cell forming systems with new stem cells or donated bone marrow into these patients which rids the body of both HIV and cancer. However, stem cell and bone marrow transplants have a high risk of dangerous complications and death that “far exceeds the possible side effects of medications that can control HIV.” But successful transplants create a rare natural genetic mutation (CCR5Δ32) that doesn’t allow HIV to enter white blood cells. A patient who was part of this trial has not been taking any medication and has been considered HIV-free for two years. Associate chief of the Division of Infectious Diseases at Weill Cornell Medicine Dr. Marshall Glesby believes that although “there’s no clear definition of when you can say someone has been cured, …it’s looking very promising.”
The clinical trial of 2009 hasn’t been our only source of hope. There is currently a trial being done that is helping to transfer HIV patients from daily medication to taking nothing at all. In this trial, patients receive IV infusions along with many other injections to deliver long-term treatment into the body. The ultimate goal is to get the immune system to fight off the virus on its own without the help of medication.
Two Weill Cornell research groups are currently studying how HIV interacts with the body. HOPE Collaboratory researchers are “looking for ways to identify the sleeper cells that harbor the virus and examining places within the body where it may find shelter from the immune system’s defenses. The REACH Collaboratory is “exploring how populations of virus-harboring cells change over time, and how some escape the immune system, even as they continue to produce new HIV.” HOPE Collaboratory researchers are trying to secure the dormant virus in place while leaving its DNA intact. To do this, “they are taking cues from ancient viruses buried in the human genome.” Dr. Douglas Nixon, a professor of immunology in medicine at Weill Cornell Medicine believes that in order to understand the best way to get rid of HIV we need to understand how we naturally control these ‘fossil viruses.’” Scientists at HOPE are trying to find drugs that could change the genetics of HIV “rendering the modern virus inert like its predecessors.” Current studies are examining ancient viral remnants within CD4 T cells to understand “how… these genetic fossils compare with HIV embedded within the same type of cells” as well as if the cells could “exert similar control over the modern infection.”
Although it may still be a long time until an HIV vaccine or treatment is found, Dr. Lishomwa Ndhlovu, who is involved in a company that is developing therapeutics to treat HIV, believes that destroying the DNA of HIV “would be the ‘coup de gras’ against HIV.” If scientists are able to successfully eliminate “the virus from cells’ genomes using molecular tools” using the genome editing system CRISPR-Cas9, the future for those with HIV will look very bright.
