From 2011 IAS Conference: Towards an HIV Cure Eric Verdin Presentation
Towards an HIV Cure: Eric Verdin, from Gladstone Institute, addressed this issue during a Plenary Session on July 20th at the 6th International AIDS Society (IAS) Conference in Rome. Verdin is a well known authority in HIV latency.
There are today more than 25 approved ARVs on the market, but all of them are unable to cure HIV.
WHY DO WE NEED A CURE?
"The journey of a thousand miles begins with one step" said Lao Tzu, this is exactly the situation towards a cure told Verdin. He are listed the main reasons for a cure:
-Despite effective viral suppression on ART, HIV persists and also rebounds after drugs are stopped.
-Despite ART, patients still experience significative morbidities. HIV and ART might accelerate the aging process.
-There can be residual viral replication on ART and chronic immune activation.
IS A CURE FEASIBLE AND WHAT TYPE OF CURE?
It can be a functional or a sterilizing cure. There are already examples in patients: Elite controllers and the Berlin patient. This Berlin patient told us that HIV infection and persistence are highly dependant on CCR5, and questionned the role of tissues non bone marrow derived virus. Elite controllers told us than HIV can be suppressed without drugs, by the immune system.
WHY ART FAILS TO CURE AND HOW DOES HIV PERSISTS?
-HIV can remain in CD4 cells due to latency. This is a rare event, concerning 1 cell in 100,000 or in 1 million. Purging the latent reservoir is one of the goals. HIV transcription is controlled by Cis and Trans-acting factors, and the site of integration of the virus is also important. Several transcription factors have now been identified as involved in the control of HIV latency. With the group of Carine Van Lint, Verdin identified several years ago the first evidence of HDAC role in HIV latency. Ivan Hirsch demonstrated the role of DNA methylation. Pomerantz studied the action of Prostratin and Siliciano the role of Disulfiram as reactivating agents.
-HIV also persists in other cells like stem cells
-HIV also persists in body sanctuaries
HOW CAN WE CURE HIV: A ROAD MAP
Three directions were given by Verdin:
-intensification and treating early are the most obvious first steps
-therapeutic vaccination could lead to an Elite controllers state
-stem cell therapy could lead to the Berlin patient state
Key words: IAS HIV Cure, towards HIV cure