HIV: No cure yet, despite intense research, heavy funding

HIV: No cure yet, despite intense research, heavy funding

BY VERNON DAVIDSON
Executive editor — publications
davidsonv@jamaicaobserver.com

Sunday, December 01, 2019

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Hope soared in the global medical community in March this year when researchers reported that a man, who was treated by specialists at University College London and Imperial College London for advanced Hodgkin's lymphoma, had been functionally cured of HIV.

According to a UNAIDS report, the man had received the treatment in 2016 using stem cell transplants from a donor who carried a rare genetic mutation.

After he stopped taking antiretoviral medicine in October 2017, researchers found that HIV had been undetectable in him.

That was the second case of a reported functional cure for HIV. The first was that of Timothy Ray Brown, who received a similar treatment for cancer in Berlin, Germany in 2007.

At that time enthusiasm was high in the medical community. But after that breakthrough, and the one in March this year, former UNAIDS Executive Director Michel Sidibé sounded a note of cautious optimism.

“To find a cure for HIV is the ultimate dream,” said Sidibé, who is now Mali's minister of health and social affairs. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”

After the case of the unnamed patient was reported in March, UNAIDS pointed out that stem cell transplants are highly complex, intensive and costly procedures with substantial side effects and are not a viable way of treating large numbers of people living with HIV.

“However, the results do offer a greater insight for researchers working on HIV cure strategies and highlight the continuing importance of investing in scientific research and innovation,” added UNAIDS.

Research on HIV has been extensive, but to date scientists have not been able to find a cure for the disease which, since its discovery 36 years ago has infected approximately 78 million people and resulted in the deaths of 35 million worldwide.

“HIV is one of the conditions where we've had maybe the most research ever for any disease, and the largest amount of funding towards fighting the disease,” AIDS Healthcare Foundation (AHF) Caribbean Regional Director Dr Kevin Harvey told the Jamaica Observer in an interview ahead of today's observance of World AIDS Day.

“Over the last 30 years we've seen the development of many, many different drugs, probably more than any other condition. And where we are now, the science has shown that despite the fact that you can't rid the body of HIV totally, if you're on the medication — and the medications that they have now, the most recent ones — within three months to four months, maximum six months you are virally suppressed... meaning that you can't transmit it to someone else, even if you have unprotected sex,” Dr Harvey said.

He referenced the U=U (Undetectable equals Untransmittable) information campaign, which basically indicates that if an HIV-positive person is on HIV medication with a consistently undetectable HIV viral load, the HIV virus cannot be transmitted to a sex partner.

“That is where we've gotten to in terms of the science,” Dr Harvey said.

“In terms of a vaccine, they have not gotten to the stage where they have a vaccine that can prevent HIV...

“So they have what is called PREP, which is using the medication to prevent infection... and they also have what's called PEP — post-exposure prophylaxis — using, again, the drugs to prevent you from developing the disease despite being exposed. So the drugs are the saviour in all of this, but we have not found a cure after extensive research and funding,” he told the Sunday Observer.

But while Dr Harvey appeared satisfied with the availability of medication, he was obviously disappointed that more HIV-infected people were not being treated.

“We've also failed in prevention, because, despite the fact that we have the drugs which work, we have not got enough people on treatment. So Jamaica, with 32,000 persons infected only has 12,000 persons on treatment, so we're less than half of where we need to be,” he said and pointed to the 2020 target which is to have 90 per cent of infected people on treatment.

“So we are way off from that. And then, to get persons who are on treatment to be virally suppressed, we're still lagging behind in terms of implementing some of the newer medications that are out there,” Dr Harvey said, adding that “some of the newer medications are reasonably priced, so money is not the issue”.

He did not name any of the new medications, but in April this year United Kingdom-based charity Avert reported that the United States Food and Drug Administration had approved the first complete HIV treatment regime containing only two antiretroviral drugs.

“This move will make the treatment available for people starting first-line antiretroviral treatment,” said Avert, which has been providing information about HIV and sexual health worldwide for more than 30 years.

According to Avert, marketing approval for the drug named Dovato, “means that treatment-naïve individuals can benefit from a highly effective regime with fewer component drugs, reducing their lifetime cumulative exposure to different drugs and potential long-term toxicities”.

However, the charity said that “Dovato comes with one warning for people co-infected with hepatitis B, given the reported resistance to lamivudine for this population”.

In addition, the manufacturers advise that “women wishing to conceive should avoid using Dovato at around the time of conception, given the reported dolutegravir-associated toxicities for the embryo”.

Last Friday, the New York Times reported that Indian generic drug manufacturer Cipla announced a new, more palatable paediatric drug, called Quadrimune, which “comes in strawberry-flavoured granules the size of grains of sugar that can be mixed with milk or sprinkled on baby cereal”.

According to the newspaper, experts said the new drug could save the lives of thousands of children each year.

The development was welcomed by UNAIDS' new Executive Director Winnie Byanyima, who is quoted by the newspaper as saying “This is excellent news for all children living with HIV. We have been eagerly waiting for child-friendly medicines that are easy to use and good to taste.”

Last Wednesday, South Africa announced that it was introducing an affordable, cutting-edge antiretroviral drug to fight HIV.

According to the country's health authorities, the tablet, known as TLD, is “the fastest way to reduce HIV viral load”. It will be rolled out today, World AIDS Day.

The medications issue aside, Dr Harvey is also unhappy that here in Jamaica, and overseas as well, the promotion of condom use and prevention education, particularly targeted at young people, have faltered.

“I don't know if you remember the days 10 years ago, five years ago, when we had major campaigns on TV and radio around condom use. We had major campaigns about adolescent health and sexual health in schools and access and condoms — they were robust discussions. And so the population was exposed to those kinds of issues, but all of that stopped maybe five to eight years ago,” he said.

Asked why, he replied: “Well, funding for one thing, because the donors started to move away from funding general population issues, which are the prevention issues, and they preferred to fund specific targeted group interventions. But some of it [was] political; you have heard of some of the fallout in the sexual health and education curriculum in schools. But if you think about it, that last eight to nine years, even 10 years, if you look at it, the children who were 10 and five, 10 to 15 year olds then, are now 15 to 25. They have actually missed out on that robust discussion about HIV. So there was nothing on the media for a long time.”

However, he sees hope in a new campaign, titled 'Do it for your best life', which was built by AHF and is currently up and running.

“So, we are trying to put back some of these kinds of things … but we have actually fell down in terms of the prevention. So, we're not seeing the drop in new infections that we would have liked to see, and we are not seeing the responsible behaviour that we would have liked to see,” he said.

(See related stories in Your Health Your Wealth)


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