What Does a Cure for AIDS Really Mean?
The following Questions and Answers surrounding a Cure for AIDS was created by amfAR, which is focusing on funding HIV research for almost 30 years. To learn about the amfAR Countdown to a Cure for AIDS campaign, go to our Cure Awareness Videos located here.
Why does amfAR believe a cure is possible by 2020?
The scientific obstacles to a cure have, for the first time in history, been clearly illuminated. With a directed, collaborative and aggressive research effort, we believe that these challenges can be overcome if we make the right investments now.
What has changed since the start of the epidemic, 30+ years ago, to make the idea of a cure more plausible?
Perhaps the most important development has been the case of the Berlin Patient (Timothy Ray Brown), the first person to be cured of HIV, which was first reported in 2008. The case provided a proof of principle that a cure was possible. Up until that point, AIDS research was largely a process of discovery. Now, knowing the key scientific questions that need to be answered, we’re moving into a new phase of problem-solving research that is more of a technological challenge.
How does amfAR define cure in relation to HIV/AIDS?
To be considered cured, an infected person would need to meet three criteria: 1) be able to live a normal, healthy lifespan; 2) be off antiretroviral therapy or any other HIV-related medications; and 3) be incapable of transmitting the virus to others.
What are the scientific roadblocks to finding a cure?
There are four scientific roadblocks to finding a cure. First, we need to Chart the locations of the reservoirs of virus that persist even when a person is taking antiretroviral therapy. Second, we need to Understand how these persistent reservoirs are established and maintained. We also need to Record the amount of virus contained within the reservoirs. And finally, we have to Eliminate the reservoirs and other adverse consequences of HIV infection (e.g., immune dysfunction). If we do these four things, we’ll have a CURE.
Will one cure work for all HIV strains or will multiple “cures” be needed?
Research will tell us the answer to this. There are several factors that may influence the effectiveness of a cure, including how long the person has been infected; the route of infection; the person’s age when he or she acquired HIV, as well as current age; how soon they started antiretroviral therapy; and whether they have opportunistic infections or other HIV-related health problems. Depending on the nature of the cure, the HIV strain may also influence the type of cure needed. We might start by curing some of the people some of the time. It might be that there won’t be a single cure for all, but at this stage we can’t say for certain.
What testing will be implemented in order to confirm that a cure for HIV has been identified—and how will acceptance by the scientific community at large be confirmed?
We need highly sensitive tools to measure the size of the reservoir and its ability to actively replicate if antiretroviral therapy is withdrawn (as noted in the “roadblocks” section above). Once these tools have been developed and validated, we will be able to determine whether or not a person is cured. The ultimate tool to test a cure will be time, and it may take several years.
To date, there have been three landmark cases representing three types of potential cure: the Berlin patient, the Visconti cohort, and the Mississippi child. Are these cure methods not broadly applicable to others?
These approaches may not be broadly applicable, but we’re learning a lot from them that will help us find a cure that is broadly applicable to anyone who is living with HIV around the world.
- Timothy Ray Brown (“the Berlin Patient”) required a stem cell transplant to treat his cancer (very unusual), and received cells from a donor with a genetic mutation that made him highly resistant to HIV infection (again, highly unusual).
- The VISCONTI cohort patients all started therapy within a few weeks of infection (very unusual) AND decided to stop taking therapy (highly inadvisable).
- The Mississippi child was born to a mother not in medical care (highly unusual) and was treated with a treatment dose of antiretroviral therapy within two days of birth (exceptional).
We’ve had many breakthroughs in HIV cure research over the last few years, but what about the setbacks, including Dr. Henrich’s patients, who appeared to be HIV-free following stem-cell transplants and later experienced a resurgence of virus? How do these events impact the current state of research?
Every piece of research, in a test tube or a patient, is an opportunity to learn what might work and what doesn’t work. In those cases where an intervention doesn’t work, we can learn why not and thus gain a better idea of what will work.
Clinical trials often take between eight and ten years to be completed. Is having a cure for HIV by 2020 even feasible?
Our goal is to achieve the scientific underpinnings of a cure by 2020. The likelihood is that, once we know what a cure looks like, it will be some time before it is thoroughly tested and then put into production. It is difficult to know how long that process will take.
The following are some key commonly asked questions about a Cure for AIDS
Why Do We Need a Cure for HIV/AIDS? Isn’t The Medicine Effective?
AmfAR’s research has led to the development of effective anti-retroviral HIV treatment. These medicines keep people with HIV healthy (so their HIV infection doesn’t turn into AIDS); they prevent the spread of the virus from mother-to-child (so babies are born HIV-free); and they double as prevention in people living with the virus as they can reduce the chance of transmission to non-affected people by 96%.Treatment can also serve as prevention in people not living with HIV. When taken within 72-hours after potential exposure to the virus, HIV treatment can prevent transmission. This tactic is called “PEP” for “post-exposure prophylaxis.” For more information: http://1.usa.gov/1aLA6Ve. And, new data show that taking treatment prior to exposure to HIV can also reduce one’s risk of contracting the virus. This approach is called “PrEP” for pre-exposure prophylaxis (many factors impact the percent of risk reduction; the results in studies have ranged from a 44%-90% reduction of risk). For more information: http://1.usa.gov/17jbSzA. Finally, when pregnant, HIV-positive women and their newborn babies are given antiretrovirals, the risk of mother-to-child transmission of the virus can be all but eliminated.Since antiretroviral treatment can prevent the spread of HIV, scientists wondered if it was possible to end the AIDS pandemic through treatment alone.Their conclusion? No.There are three main reasons:
- Too few people globally are on treatment. Of the 35.3 million people estimated to be living with HIV, only about 9.7 million currently have access to treatment.
- Many people don’t know their HIV status (including 20% of all people living with HIV in the U.S.) And, there is a “window period” between when people first contract HIV and when they will test positive for the antibodies to the virus. If people are tested in this “window period” they could get a false negative test result but still be positive. Therefore, there could always be people living with the virus who aren’t aware they have it unless they are repeatedly tested.
- The stigma surrounding HIV makes people, understandably, afraid to get tested and treated for HIV.
So, getting all people with HIV around the world to be aware of their status before they unwittingly pass the virus to others, and providing and paying for treatment for the remaining 25.6 million men, women and children with HIV is a real challenge and an incredible expensive. Even if it could be done, the medications have some serious side effects. Therefore, the optimal solution to HIV is a cure.Until we have a cure, and likely for years after while we work to get people cured, efforts to prevent the spread of HIV (including the pursuits of HIV vaccines) and programs to test and treat as many people as possible must continue.But one thing is certain: Without a cure, AIDS will never end.The good news is there has never been a more exciting or promising time in AIDS cure research. In the last twelve months, multiple, significant scientific breakthroughs related to an AIDS cure have been made.
Is It True Some People Have Been Cured?
Yes. As of July 2013, 18 people have been declared functionally cured of HIV.AmfAR’s research supported four of these cases. All four were American. The first was Timothy Brown, known as The Berlin Patient (as he was cured while living in Germany by Gerald Hutter, a German oncologist). HIV was eradicated from his body through a stem cell transplant using cells immune to HIV. You can read his story here: http://bit.ly/13fb5v9. The second was a young child in Mississippi, who was given medication shortly after being born with HIV. Read her story here: http://nyti.ms/15rOhvL. The other two cases were two men who were also cured through a stem cell transplant, but using cells not immune to HIV. Read their stories here: http://bit.ly/13fbmhD.Shortly after the news of the pediatric cure case, news of a French cohort of 14 patients believed to be functionally cured of HIV hit the news. Read about the French patients here: http://bit.ly/Z2EjLO.While none of the ways these various patients have been cured is easily or safely replicable, AIDS cure research scientists are working to translate the insights from these recent cases into a cure that will hopefully work for many.
What Types of Cure Are Being Pursued?
In the most fundamental sense, there are two basic types of AIDS cure:
- Functional Cure
- Sterilizing Cure
The definition of a “functional HIV cure” is that people living with the virus no longer have to take medicine and they remain healthy and non-infectious, whether or not every trace of HIV has been removed from their body. A “sterilizing” cure is one that removes all traces of HIV from a person’s bodies.While there is scientific agreement that the 18 aforementioned people may have been functionally cured, the jury is still out on whether any of these patients have also experienced a “sterilizing” cure. It is believed that Timothy Ray Brown is the only person in the world that has a sterilizing cure.
To read about the various ways people have been cured, read “Three Types of HIV Cure” by Dr. Rowena Johnson, vice president and director of research for amfAR here: http://bit.ly/138wgne. When might we have a cure for everyone?While no one can say for certain, the recent spate of cures has shed significant light on AIDS cure research and greatly accelerated the hunt for the cure.It could be closer than many realize. Leading scientists around the world agree a cure for HIV is possible in our lifetimes. Dr. Francoise Barre-Sinoussi, Director of the Louis Pasteur Institute in France and the winner of the Nobel prize in 2008 for her co-discovery of HIV with her colleague Luc Montagnier said, on CNN, “What we are sure is that we think it’s reasonable today to say it’s feasible to have a cure. A functional cure. I believe that if we work like in the early years of HIV, all together, we can move forward very fast as well for an HIV cure.”
How Can I Be Here for The Cure?
As we mentioned, being “here for the cure” means two things: 1) supporting research scientists as they close in on an AIDS cure and 2) knowing your HIV status so if you’re living with the virus you can connect to care to ensure you stay healthy enough to be here when the cure is finally here. To support the scientific hunt for the cure, click here to go to our “Take Action” page which will direct you to ways to get engaged. As for knowing your status, HIV testing is quick, painless and can be free and anonymous. There is now an over-the-counter HIV test that you take by running a plastic swab over your gums that can give you a result in 20 minutes in the privacy of your home. It’s called the “OraQuick ADVANCE Rapid HIV ½ Antibody Test,” is made by Orasure Technologies and is available at drugstores around the U.S. Its results do need to be confirmed by professional blood work. For more info on the test: http://bit.ly/2Rcuz. To find a place to get tested for HIV, visit http://www.AIDS.gov.If you discover you are living with HIV, be aware that it has been proved that starting medications earlier than previously thought increases your chances for health and survival. The World Health Organization (WHO) released their revised global guidelines for HIV treatment in July of 2013. See the new guidelines here: http://bit.ly/17LeJWa.