Not many years ago, the idea of defeating the resilient virus that causes Aids was far-fetched. But as 18 000 people gathered in Durban this week for the 21st International Aids Conference, the prospect of a cure is plausible enough that it is attracting increasing amounts of money, scientific research and attention.
The conference comes little more than a month after the UN committed to action to end the Aids epidemic by 2030, despite formidable obstacles. Leaders of the global battle against HIV have described 2016 as a pivotal year in their effort.
“Achieving such a cure is one of the great scientific challenges ever undertaken,” Françoise Barré-Sinoussi, one of the discoverers of the virus, told reporters in a news briefing.
“Our challenge is to take the science forward.”
Worldwide funding for research on a cure rose to $201.8 million last year, up 25% over the previous year and more than double the $88.1m spent in 2012, two years after the International Aids Society launched a programme to achieve a cure.
Most of the money comes from governments around the world. Last week, the National Institutes of Health (NIH) awarded $30 million (R428m) annually for the next five years to six US research centres working towards a cure.
Also scheduled for this year, is a large-scale clinical trial of an HIV vaccine, which will be conducted in South Africa and co-funded by NIH.
“The two greatest challenges remaining in HIV/Aids research are finding a cure and developing a safe and effective preventive vaccine,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is leading the vaccine trial.
Research scheduled to be presented at the Aids conference includes several strategies for a cure, including gene editing and stem-cell therapy. The positive long-term impact of antiretroviral therapy will also be discussed.
Transplanting stem cells from a donor known to be immune to HIV is expensive and risky. This technique was used on a patient who was being treated for acute myeloid leukaemia and is not practical for other people. But it did produce the one recognised cure in the history of the disease, according to a preview of the International Aids Society’s updated scientific strategy for a cure, which was published online recently in the journal Nature Medicine.
The hurdles to a cure include the adaptability and persistence of the virus. It took decades to turn HIV from a death sentence into a chronic, manageable disease through antiretroviral therapy, and few are willing to predict when a cure might be feasible. The suppressed virus can lie dormant for years but may re-emerge and cause infection if medication is halted.
“There are now a number of potential therapeutic strategies that could conceivably achieve this goal, once considered aspirational,” researchers, including Barré-Sinoussi, wrote in the Nature Medicine article. “The challenges, however, remain substantial.”
Some believe that sustained remission – the suppression of the virus to almost undetectable levels for a long period – may be a more realistic goal.
Also, financial support for anti-HIV activity fell in low- and middle-income countries for the first time in five years, according to a new report by the Kaiser Family Foundation and UNAids.
The effort to spread access to current therapies remains a central focus of public health experts, policymakers and people with HIV. About 17 million people worldwide had access to antiretroviral drugs last year, a sharp rise from 7.5 million five years earlier. About 2 million people worldwide started on therapy last year, almost as many as the 2.1 million who were newly infected.
But 1.1 million people died of Aids last year, and 22 million were not receiving treatment, according to the UN. About 36.7 million are living with the virus. Roughly two-thirds of new infections occurred in sub-Saharan Africa.
By 2020, the UN’s 90-90-90 strategy calls for 90% of all people with HIV to know their status, 90% of those diagnosed to be receiving sustained therapy, and 90% of those under treatment to have suppressed the virus.
The Washington Post