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20 Years Ago, HIV Had No Medicine, Now There Is Countdown To A Cure

Mercury

Jan. 07, 2020

Since the introduction of highly active antiretroviral therapy or HAART, as this combination therapy approach, is called, HIV/AIDS has evolved into a serious, but a chronic disease with survival stretching into decades.
Moreover, this "cocktail" approach to treatment where drugs are combined in different ways or different sequences has become a model for treating other diseases ranging from lung cancer to heart disease.
"In 1996 a 20-year-old person in the U.S. with AIDS expected to live about three to five years and now expects to live to be 69 years. That is amazing," said John Bartlett, MD, past president of the Infectious Diseases Society of America. "Think of it -- in 1996 everyone in our HIV clinic was prepared to die. Now they all live. And most of them look great. They just need to take the meds."
"Next challenge is the cure," said Bartlett.
In more than a decade since the emergence of HAART, researchers have constantly refined the regimens to improve results, with evidence now emerging that some combinations may be more affecting patients with more extensive disease.
Thomas Coates, MD, of the University of California Los Angeles, pointed out that the HIV death rates are still dropping due to continual HIV research.
"The drop in death rates from HIV in the developed world (is) due to improved medications," Coates said. "There was the 10 percent drop in deaths due to HIV in the US between 2006 and 2007."
In Africa, where the HIV/AIDS crisis hits the hardest today, Coates said doctors are slowly making progress-and in some cases real gains, which is the case with the use of antiretroviral drugs to block mother-to-infant HIV transmission.
"It has made a big difference in the developed world where vertical transmission rates have plummeted from over 1,000 at the peak to fewer than 100 per year (in the US)," said Coates. "Advances are being made in the developing world, with Botswana leading the way, not with a 3% vertical transmission rate. It was the first and still is the most effective prevention strategy we have."
There has never been a more optimistic time in the world of AIDS research.  New breakthroughs over the last several years have brought the scientific community a new understanding of the challenges that must be overcome to get to a cure. And there is growing confidence that, with the right investments, these challenges can be overcome.
The case of the Berlin Patient, first reported in 2008, was a watershed moment in the field of HIV research and a proof of principle that a cure was possible. In 2013, a group of French patients was reported to be in sustained remission.
These and other advances have created a groundswell of optimism about the prospects for a cure. This momentum, coupled with the availability of new and emerging technologies, has led us to believe that now is the time to mount an all-out effort to find a cure and finally bring the global AIDS epidemic to an end.
The Challenges of Curing HIV
amfAR has established a “research roadmap” that identifies the four key scientific challenges that represent the principal roadblocks to a cure:
Chart the precise locations of viral reservoirs that persist in the body;
Understand how HIV persists in the reservoirs;
Record how much virus they hold; and
Eliminate the virus 
To reach the ambitious goal of a cure by 2020, amfAR is changing the way it funds research by moving away from a passive investment strategy to one that will be more aggressive and focused on collaborative approaches to addressing the unanswered questions.  To help direct the research and to ensure that investments are made in the most promising areas, amfAR will establish a “Cure Council,” a volunteer group comprising some of the world’s leading HIV/AIDS researchers.
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, 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, they're moving into a new phase of problem-solving research that is more of a technological challenge.
Clinical trials often take between eight and ten years to be completed. Is having a cure for HIV by 2020 even feasible?
The likelihood is that, once they 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 but many are optimistic it is 2020.
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