Anyone who was in their teens or twenties in the 1980’s in the UK cannot fail to remember the ‘Don’t die of ignorance’ campaign launched when the first cases of HIV/AIDS were diagnosed and making the headlines.
Hard-hitting, uncompromising and frankly frightening, this ad campaign certainly underlined the ‘death sentence’ perception of an HIV diagnosis at that time. Indeed, in many senses, this wasn’t just a perception. In the early to mid 1980’s the likelihood of survival was very low with the toxic AZT being the only line of defence to a virus which ravaged segments of the gay and hemophiliac communities. At that time, the idea of HIV being a manageable let alone a treatable condition was simply fantasy.
The stigma associated with a diagnosis at that time cannot be understated.Yet, if the condition had any anything at all working in it’s favour it was the high profile names that fell foul of the infection.
The announcement that Rock Hudson, known for his rugged and powerful acting performances was the first I remember having a wider public impact.blo Then, the communal intake of breath as Queen’s lead singer Freddie Mercury bravely appeared in public. The sight of him as a gaunt and sunken figure, a weakened and reduced version of the powerful character we all thought we knew. That struck a chord with so many people at the time. The power and aggression of the HIV/AIDS virus at that time was suddenly seen as something that must be overcome.
Since that time, progress quite simply unimaginable at the time has been made. From dozens of fairly toxic tablets three of four times a day we have now progress to a point where combination therapy means the condition is treated as manageable – much like diabetes. Many people currently living with the virus take just one tablet a day and have a near normal life expectancy experiencing little in the way of side effects.
However, despite this progress, the condition can only be managed, not cured. However, as researchers in different fields combine their results, there is real hope that the prospect of a cure for HIV/AIDS in infected people may be on the horizon.
The first piece of good news comes from the University of Oxford which reports that the natural evolution of the virus is producing gradually weaker strains. As the virus has spread, it has had to evolve to survive. Every so often the virus meets a strong and effective immune system. If it doesn’t evolve it will be destroyed – so it changes. But those mutations typically result in a drop in the ability of the virus to replicate. That in turn makes it less aggressive.
Professor Phillip Goulder and his team at Oxford even believe we may reach a point where the HIV virus becomes virtually harmless to humans in future generations merely by this process of ‘watering down’ by natural mutation.
The complexity of the infection cycle means that researchers have been able to tackle different stages of the process. One seeks to starve the virus of the building blocks it needs to replicate within a ‘hijacked’ cell.
Researchers at the University of Rochester medical center identified the building blocks needed within the cell to allow the virus to replicate. These building blocks are referred to as deoxynucleoside triphosphates or dNTPs. They also identified that a protein SAMHD1 can break down these dNTP’s – effectively starving the virus of the building blocks it needs to continue replicating itself. Whilst this research is in the early stages it provides a new route to tackle the spread of the virus within the body.
The second line of attack may come with a change to the prescription regime of the most effective combination therapies. At present, treatment is routinely left until the immune system is compromised. However, studies in London based on early intervention and treatment have shown significant variation based on the start point of treatment.
The Spartac study, which involved 366 patients from eight countries around the world, tested the theory. Some patients were given 12 weeks of drugs after being diagnosed, another group had drugs for 48 weeks after diagnosis and a third group were given no drugs until they reached the levels at which treatment would currently be started.
Prof Jonathan Weber, from Imperial College London, said those on the 48-week regime “end up with much higher CD4 cell count and a much lower viral load”. – In simple terms, their immune system remained stronger and the number of copies of HIV found in the blood was significantly lower.
Recent developments in combination therapies mean that there are now very effective ways of tackling the virus when it is travelling in the blood stream. However, the challenge is that much of the virus remains in ‘reservoirs’ within the body (the gut, brain and bones being examples) where the combination therapy is unable to tackle these dormant virus copies.
This research uses medication currently used in the treatment of lymphoma to flush the reservoirs into the blood stream of the host. Whilst this leads to an initial rise in the viral load of the individual, it also means the virus can now be tackled by existing combination therapies. Whilst still in the early stages of clinical trials, this holds out the real prospect of ultimately being able to ‘clear’ the virus from the body.
It is unlikely that any one of these approaches will be successful alone. However, as research from a variety of disciplines start to come together, the possibility of enhanced combination therapies including some or all of these strands becomes far more real.
Although nobody is promising a ‘cure’ for HIV/AIDS the progress made over the past 30 years is staggering. With new avenues such as these becoming viable treatment methods, the next 10 years can truly be said to hold real promise for those living with HIV as well as wider medicine where these approaches may be replicated for unrelated conditions.