Which suggests that this is a regimen that could be improved. He was diagnosed with HIV in and was put on a standard HIV regimen and has been undetectable, apart from one 'blip', ever since. In September he was enrolled in a treatment intensification study, to see if adding extra drugs to an HIV regimen will increase viral suppression rates.
Dolutegravir is a durable integrase inhibitor which is now the basis for many HIV drug regimens, but which five years ago was still a relative newcomer. Then they also added maraviroc Celsentri. This is an interesting one. Maraviroc was the first CCR5 inhibitor, which means it attaches to cells, rather than to the virus, and stops it entering. Maraviroc was licensed in but has struggled to find a place, either as treatment or PrEP.
Its potency has been underwhelming, possibly because to work properly it would have to attach to every infectable cell. But an extremely suppressed viral load might allow maraviroc to prevent any further cells being infected.
One group just got the intensified antiretroviral regimen. But the other groups also got a sixth drug. One group got a therapeutic vaccine, custom-made to suit their viral subtype. The third group got what is called a 'Sirtuin Histone deacetylase inhibitor'.
This sounds very hi-tech until you realise that this is nicotinamide, a. To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today.
The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. The Induce and Reduce agents will all be given while people are on suppressive ARV therapy to protect healthy cells from the virus. While it may sound straight forward, it has been a major challenge to reactivate the virus in animals or people in an effective and safe way. New pioneering research on the induce strategy was recently published in the journal Nature.
This research, which was made possible through the collaboration of ViiV Healthcare and its partners at UNC-Chapel Hill and Emory University, summarised a scientific breakthrough in our efforts to push the reservoir virus out of hiding in two HIV animal models.
For the first time, using a class of drugs new to the HIV field known as IAP inhibitors Inhibitors of apoptosis , a signaling pathway in cells was activated that could induce the hidden HIV to reactivate and become visible, while having relatively few other effects on the healthy cells.
At the same time, our researchers are also focused on developing companion molecules that will target cells with the newly exposed HIV to reduce the reservoir. If successful, the advancement of these molecules in combination could provide one of the strongest paths forward to curing HIV. The research required to develop an HIV cure is complex and requires a commitment to the long-term. To report a suspected side effect, please use our online reporting form. All rights reserved.
The other way is to induce cells to make viral antigens or virus-like particles that the immune system then reacts to. If there was such a vaccine could be used both therapeutically as well as in prevention, by stimulating an immune reaction to activated HIV-infected cells. Kiem said that the way scientists have been trying to get round this is to only select and alter so-called haematopoeic stem cells HSCs. These rare and long-lived cells, found in the bone marrow, are the replenishing reservoir of the immune system.
They differentiate when they reproduce and give rise to all the immune cells that do different things: CD4 and CD8 T-lymphocytes, B-cells that make antibodies, macrophages that engulf pathogens, dendritic cells, monocytes, natural killer cells, and others.
They would be ready when a new HIV infection comes along if used as a vaccine or when HIV viral rebound happens and there is detectable virus in the body if used as part of a cure. If a person with CAR-engineered stem cells could have repeated cycles of treatment interruption, their HIV reservoir could in theory slowly be deleted. As mentioned above, although genetic medicine shows enormous promise, the complexity and expense of its techniques means that at present it is unlikely to benefit most people who really need it.
Hans-Peter Kiem said that currently about 60 million people have conditions that could benefit from gene therapy. The vast majority of these either have HIV 37 million or haemoglobinopathies — blood-malformation diseases such as sickle-cell anaemia and thalassaemia that are also concentrated in the lower-income world 20 million.
Dr Jennifer Adair, one of the first researchers to have proposed collaboration on gene therapies for HIV with African institutes, said that gene therapies have already been licensed for conditions such as thalassaemia, spinal muscular atrophy, T-cell lymphoma and a form of early-onset blindness.
But they are astonishingly expensive. The price is not just due to the cost of the complex engineering used to make them, but because they are used to treat rare diseases and so have a small market.
At present the technology need to engineer autogenic genetically engineered cells is, if anything, even more expensive and complex than that needed to introduce allogenic cells. It can involve in the region of ten staff and a workspace of 50 square metres per patient. Undaunted by the challenges, the US National Institutes of Health are collaborating with the Bill and Melinda Gates foundation to work on a combined programme of HIV and sickle-cell-anaemia genetic therapy given that something that works for one could be adapted to work with the other.
And the Fred Hutchinson Center has teamed up with the Joint Clinical Research Centre in Uganda with the very ambitious goal of making a genetic therapy that would be at least ready for human testing within two years in an African setting, and that could be scaled up to be economical for Africa if successful.
The US Food and Drug Administration projects that based on the current rate of progress and the development pipeline, they may be licensing around gene-therapy products a year by This branch of medicine is no longer exotic, she said.
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