THIS week, I continue from last week an article sent to me by Samuel Kumar, an HIV/AIDS activist.
Concept behind the cure
HIV hides in latent Memory T cells and infants don’t have long lived immunological Central Memory CD 4 T cells may help in immunology.
Babies have Naïve T cells that have not been exposed to infections/pathogen. Hence the virus has no hideout and no time to form Latent Reservoirs in the Memory T cells.
The virus was stopped from replicating by the administration of early HAART.
3. TWO BOSTON MEN underwent stem cell transplantation for the cancer, but this time not involving donors with genetic resistance to HIV.
They received mild chemotherapy which allowed them to stay on their antiretroviral medication throughout.
Although HIV was detectable in their cells immediately after the transplant, overtime the uninfected donated cells replaced the infected cells.
Both patients appear to be HIV-free, one of them two years and the other three-and a-half.
4. Following on the heels of ground-breaking news that an American baby has apparently achieved a “functional cure” of HIV comes the announcement that 14 French adults treated within two months of infection also maintain undetectable virus levels after stopping antiretroviral (ARV) therapy.
Unlike in the elusive “sterilising cure,” in which the body would be cleared of all HIV, in a functional cure, the body can control HIV without the help of meds.
As such, there is still virus in all members of the French group, although it is only detectable with highly sensitive tests.
Drawing from the VISCONTI study, French researchers published their findings in the online edition of PLOS Pathogens. But when a person with HIV receives
aggressive treatment soon after infection, according to the hypothesis put forth by the study, the virus forms a reservoir in the shorter-lived lymphocytes. When therapy was stopped, according to this theory, the viral reservoir was extremely low.
5. Shock and kill, the proof-of-concept trial used a single dose of a histone deacetylase (HDAC) inhibitor known as vorinostat or SAHA (suberoylanilide hydroxamic acid), which is marketed as a treatment for cutaneous lymphoma under the brand name Zolinza.
Histone deacetylase is an important enzyme that contributes to maintaining latency of HIV genetic material integrated into human cells.
Finding ways to unlock “sleeper” or resting CD4 memory T-cells that hide latent HIV from the immune response and from effective antiretroviral therapy – theoretically, if HIV can be released into the plasma from these cells, antiretroviral drugs can move in to mop up the remaining virus.
6. Gene therapy may lead to what is known as a ‘functional HIV cure’ by modifying part of the body’s own genetic code in order to make cells resistant to HIV.
The ZFNs are like tiny molecular ‘scissors’ that cut out the CCR5 gene. This gene provides CD4 cells with the CCR5 molecule, a ‘co-receptor’ protein that studs CD4 cell surfaces and which is an essential anchoring point for the most common form of HIV.
Cells without the CCR5 co-receptor are effectively protected from HIV infection.
There is also research going on in creating a vaccine using CMV (cytomegalovirus) as a gene delivery tool to carry viral proteins of SIV in monkey trials, it has been shown that some monkeys eradicated the SIV efficiently.
One of the protein which HIV has on its outside is gp41; efforts are underway to make a vaccine based on gp41 as it’s a non-variable portion of HIV surface protein.
What stake holders should focus on
1. Treatment experienced patients should have access to other classes of ARVs not normally found in Africa since limiting choice of drugs will lead to drug resistance and premature death. The patient should have access to at least two fully functional drugs to achieve viral suppression.
2. Patients should have access to viral load monitoring before therapy and 4 months after therapy in order to ascertain of ARVs are working for them, if viral suppression is not achieved the patient should have access to genotypic test to have the right drug of choice. People on treatment should have access to viral load tests at least every six months.
3. There should be access to TDM therapeutic drug monitoring to assess how ARVs are absorbed.
4. Trials on patients in Zambia could be considered using HDAC inhibitors to purge viruses from resting T cells and using potent ARVs we could suppress the virus Anti-inflammatory drugs such as caspase 1 inhibitors alongside HDAC to lower inflammatory response may be considered.
3. As PLWA age, there is greater need to monitor coronary related illnesses, kidney functioning, monitoring liver toxicity and treatment for the same.
4. Stakeholders should explain myths about the virus, issues relating to the false concept of immune boosting, drug to drug interactions, etc. This will help people to deter from such products.
Zambia AIDS research foundation ( ZARF ) in partnership with Treatment Advocacy and Literacy Campaign (TALC ) will be hosting a World class HIV/AIDS training workshop that will discuss all the latest scientific advancements, virology, immunology, vaccine design, treatment, care and pathogenesis of HIV/AIDS. The two day workshop will take place on May 2 and May 3 2014 at the Golden Bridge Hotel Lusaka.
Target Groups: Medical personnel, researchers, work place counselors, community health workers, NGO’s, church organisations, guidance teachers, University students, those seeking employment in the Health & HIV/AIDS sector, advisors, DATF, and those wishing to learn the cutting edge science about HIV. Visit www.aidsresearchzambia.org for details.
ZARF wishes to thank Enock Ngoma for the tremendous support he is rendering to the fight against HIV/AIDS and on behalf of ZARF I would like to encourage him to do more in terms of articles relating to treatment and care as PLWA need more information in terms of treatment as they are likely to develop drug resistance.
Thanks a lot Samuel for the article.
For comments write to knoxngoma@gmail.com or SMS/call +260955883143
