Approaches Toward An HIV Cure: HIV Persistence, Reservoirs & Cure Workshop Takes the Lead and Moves to Miami in 2013

There are several approaches to finding an HIV cure currently being explored, and all of them have had varying degrees of success. The goal in the HIV research community at this point is to find a "functional cure" for HIV—that is, reducing the viral load in the body to a point where the body's own immune system can keep it in check, without the use of antiretroviral therapy (ART).

While ART is very effective at reducing the viral load in the blood, it is virtually ineffective against dormant HIV virus hiding within infected cells called "reservoirs." These reservoirs are the source of the remaining virus within the body, and become active once it recognizes that ART has stopped.

In 2003 we launched the first edition of the "International Workshop on HIV Persistence, Reservoirs & Eradication Strategies" in Saint Martin, West Indies. This workshop was mainly focused on the nature of the HIV reservoir and mechanisms of maintenance.

Over the years, the workshop became THE reference meeting in the field, attracting more and more scientists from all over the world.
The 5th edition, held in Sint Maarten (Dutch side of the island) in December 2011 was a blast as it attracted more than 215 researchers, many of whom from the National Institutes of Health (NIH) of America.

This last edition still focused on the pathophysiology of HIV reservoirs but contained several sessions on practical therapeutic intervention to alter these reservoirs, a clear evolution over the years.

Different approaches currently attempt to fool the HIV hiding within the reservoirs that ART has stopped. Certain types of drugs inhibit the infected cell's ability to shut itself off, keeping the HIV hiding within from going dormant. Another strategy involves using vaccination before people are exposed to the disease; this strategy is still far off, as a "functional cure" will probably be easier to find at this point.

If that doesn't work, the cells can always be genetically altered. Such a procedure has inherent risk, but the results could be astonishing. The Berlin patient—an HIV-infected man who lives HIV-free today after a bone marrow transplant with genetically altered cells—gave this area of HIV cure research a much needed shot in the arm. Research into genetic modification of cells ramped up in earnest, and two general approaches are often discussed—zinc finger nucleases and cell modification.

The key to genetic modification is the CCR5 receptor—the primary avenue in cells that HIV uses to infect. By inhibiting the cell's CCR5 receptor, it makes that cell, and the body's immune system in general, resistant to contracting HIV. Less than 2% of all people have this genetic anomaly naturally, but a less invasive surgery involving zinc finger nucleases attempts to do what a riskier stem cell transplant does. The idea is that drawing a patient's own healthy cells out of the body, treating them with these zinc finger nucleases, and re-inserting them back into the body will eventually "train" the body over time to become resistant to HIV, suppressing the virus on its own after an ART boost to start with.

These are some of the biggest advances in HIV cure research so far, and show that progress toward a cure continues. As long as the funding holds up and remains in place, a cure can't be that much farther away.

In 2013, the "International Workshop on HIV Persistence, Reservoirs & Eradication Strategies" will move for the first time to Miami, Fl, December 3-6. That means that we have 2 years to make more progress in the field and move towards more clinical trials testing an HIV cure.

Contact:
Alain Lafeuillade
CHITS
1208 avenue Colonel Picot
83056 Toulon, France
33-4-94616340