A comprehensive new strategy, developed by the International AIDS Society (IAS) and published online in the journal Nature Medicine this week, presents key priorities for research to develop what experts consider to be one of the most important global health goals of our time – a cure for HIV.
The new IAS Global Scientific Strategy: Towards an HIV Cure 2016 was developed over two years by a 59-member IAS International Scientific Working Group and reviewed through an extensive global peer consultation process.
The new strategy, which is being published prior to the opening of the 21st International AIDS Conference in Durban, analyzes recent research achievements in HIV cure research, obstacles to a cure and the strategies and priorities to advance the field. Advances in HIV cure or remission research will be a major focus of AIDS 2016, from 16 to 17 July.
“Not long ago, few considered the possibility that a cure for HIV infection could some day be possible,” says Nobel Laureate Françoise Barré-Sinoussi, co-chair of the IAS Towards an HIV Cure Initiative. “Today, thanks in part to advances such as the cure of an HIV-infected individual through a stem cell transplant, the identification of a small cohort of individuals who are able to control infection following treatment, and some noteworthy advances in cell, gene and immune therapy, the search for a cure has become a top priority in HIV research.
“In 2016, that search is marked by growing scientific interest, an increasing number of novel research strategies in development, and a new optimism that a cure or sustainable remission for HIV is feasible.”
While the development of ART regimens that can control HIV have led to dramatic improvements in the health and life expectancy of those with access to the drugs, researchers and policy makers preparing for AIDS 2016 note that treatment is not a cure. Current treatment strategies present serious limitations, including the immense economic, operational and logistical challenges associated with delivering life-long care to the nearly 37-million people now living with HIV. Individuals living with HIV must also manage adherence, drug toxicities, and the persistent immune dysfunction, inflammation and risk of co-morbidities associated with HIV infection.
The new IAS Global Scientific Strategy: Towards an HIV Cure 2016 builds on the first IAS cure strategy, published in 2012, which presented the first global roadmap to HIV cure research. This “second chapter” in the search for a cure outlines the past achievements and future priorities in basic, translational, clinical, and social sciences research, along with a new focus on aspects of HIV cure research that have achieved greater significance since 2012, including:
* The benefits of early treatment with antiretroviral therapy and the potential of post treatment control;
* The primacy of immunology in HIV cure research, and a call for increased collaboration with immunologists from other fields, such as cancer research;
* The search for tools that better measure HIV viral reservoirs within the body;
* The social science and ethical aspects of cure research; and
* Cure research in, and the need to develop approaches that will be appropriate for, resource-limited settings.
Some of the key progress made in HIV Cure research since 2012 and analysed in the new strategy includes:
* The sustained periods of aviremia in the absence of therapy achieved in an aggressively treated infant, in at least two individuals who have received allogeneic stem cell transplant, and in adults who received several years of ART initiated soon after infection.
* Evidence that early initiation of ART limits the establishment of the reservoir of HIV infection and prevents the generation of immune escape in latently infected cells.
* The development of new tools that can quantify the frequency of a cell that carries replication-competent virus, and the demonstration that some biomarkers can predict the time to viral rebound following treatment interruption.
* Evidence suggesting that HIV continues to replicate and evolve during the first six months of ART but not necessarily during long-term ART.
* The demonstration in clinical trials that some specific drugs can activate virus or reverse latency but these drugs alone don’t eliminate latently infected cells.
* The demonstration of the safety and potential efficacy of broadly neutralizing antibodies in human clinical trials, and development of novel vaccines that contained and possibly cured SIV infection when administered before infection.
* The demonstration that gene therapy with CCR5 modification is both feasible and safe.
A new analysis by the IAS HIV Cure resource tracking group and AVAC shows that global investments in HIV cure funding show a continued positive trend.
Among the key findings in the report are:
* 201,8-million was invested in cure research in 2015, an increase of 25% over the $160,8-million invested in 2014, and 129% more than the $88,1-million invested in 2012.
* The majority of investments ($187,7-million) came from the public sector. In 2015, the United States contributed the majority of public funding, with France, the European Union, Canada, Switzerland, United Kingdom, South Africa and Australia also making significant contributions to HIV cure research.
* Another $14,73-million was invested by philanthropies such as amfAR, CANFAR, Fair Foundation, the Bill and Melinda Gates Foundation and Wellcome Trust.
“The past four years have demonstrated both significant progress in the search for an HIV cure, and the importance of maintaining and expanding the pace of research in this dynamic and rapidly evolving field,” says IAS president Chris Beyrer. “With the help of our members, the IAS has advanced the HIV cure research field forward from its earliest days. This second Global Scientific Strategy Towards an HIV Cure will be an invaluable roadmap that will help take cure research to the next scientific level.”
“The community sector is critically important to the success of HIV cure research, and a proud contributor to the IAS Towards an HIV Cure initiative,” says Ugandan activist Moses Supercharger Nsubuga of Uganda, a member of the Initiative’s International Scientific Working Group. “Community representatives play a critical role in building support for and awareness of HIV cure research, in addressing the ethical issues related to cure research, and in making the world aware that an HIV cure is a key priority in the global AIDS response.”