HIV cure is the next frontier

Prevention was the biggest AIDS theme of 2011, with new study findings showing that early antiretroviral treatment can reduce the risk of HIV transmission by nearly 100 percent, and data demonstrating that pre-exposure prophylaxis, or PrEP, can significantly reduce infection – at least for some people, some of the time.

But many researchers and advocates are looking beyond the latest advances in antiretroviral therapy and biomedical prevention toward a goal that not long ago was considered too far-fetched to warrant serious discussion: a cure for HIV.

"Cure is the next frontier," said Rowena Johnston, vice president for research at amfAR, the Foundation for AIDS Research. "We want to make 'cure' into a family-friendly four-letter word."

AmfAR has put its money where its mouth is, recently announcing $2.1 million in grant awards with an emphasis on cure-focused research; among the 13 grants, three went to researchers in San Francisco. The funding will also cover fellowships to support promising young researchers in the HIV/AIDS field.

The resurgence in cure-related research in recent years has come from the realization that, even with today's highly effective antiretroviral drugs, people will not be able to treat their way out of the epidemic.

"Antiretrovirals are pretty good, but people have to adhere to them for a lifetime, they are costly, and they have side effects," Johnston told the Bay Area Reporter .

Further impetus was provided by the "Berlin patient," San Francisco resident Timothy Brown, who appears to have been cured of HIV after receiving two bone marrow transplants to treat leukemia, using stem cells from a donor with naturally resistant CD4 T-cells.

While the grueling and expensive transplant procedure is not suited for widespread use, it offers clues about how cells might be protected from the virus – clues that have spurred efforts to recreate this effect using gene therapy to artificially remove an HIV receptor known as CCR5 from patients' T-cells.

The International AIDS Society has made curing HIV one of its key focal areas. An IAS working group, spearheaded by Nobel laureate Francoise Barre-Sinoussi and Steven Deeks of UCSF, is developing a global scientific strategy for cure-focused research to be presented at the 2012 International AIDS Conference next summer in Washington, DC.

Local grants

Researchers are exploring a wide range of approaches to either completely eradicate HIV from the body or – more likely – cripple the virus enough that a person's immune system can keep it under control without lifelong daily treatment.

In addition to gene therapy to protect cells from infection, several strategies involve flushing latent HIV out of resting T-cells, making it vulnerable to antiretroviral drugs and immune defenses. Other strategies attempt to boost immune responses to tackle the virus.

AmfAR's local grants will fund three research teams at UCSF that are taking three completely divergent approaches to the problem. The grants are each for $120,000.

Koh Fujinaga and colleagues will study reactivation of HIV gene expression using compounds known as HDACs and PKC agonists. A better understanding of how HIV maintains latency in resting cells may aid development of therapies to eliminate this viral reservoir, enabling people to stop antiretroviral therapy without the virus coming back.

Hiroyu Hatano and her team will study whether angiotensin-converting enzyme or ACE inhibitors – a type of drug usually used to treat high blood pressure – can reduce the buildup of scar tissue in lymph nodes.

"Lymph nodes become scarred with collagen in response to HIV, and this scarring prevents immune cells that fight HIV from recognizing infected cells," Hatano explained. "We will test whether ACE inhibitors will decrease the amount of scarring and whether this helps the immune system to fight HIV better."

Finally, Douglas Nixon's team will study endogenous retroviruses, or pieces of ancient "junk" viral DNA in human chromosomes that can be reactivated when HIV infects cells; he hopes to learn more about the resulting immune response and harness it to produce a therapeutic HIV vaccine.

"In medical practice, viruses are not routinely cured," Johnston told the B.A.R. "We want to revolutionize not only how we deal with HIV, but also how we view and may ultimately eradicate a whole host of infectious diseases."

According to amfAR CEO Kevin Frost, the organization now spends 60 percent of its research grant dollars on cure-related research.

Support from independent organizations is increasingly important as government research budgets are reduced in the wake of the global financial crisis. Last year the AIDS Policy Project, a cure advocacy group, calculated that the U.S. government spends only about 3 percent of its total HIV research funding on cure-related studies.

"We're increasingly excited about the work that emerges from the cure-focused studies we fund," Frost said. "As we keep uncovering new information about the virus, we're increasingly confident that we will be able to find a cure for HIV/AIDS in our lifetime."

Scientists on path to HIV cure

It's been thirty years since HIV-AIDS made world headlines but there's still no cure for the disease.

The most notable advance against HIV-AIDS has been a combination of anti-retroviral drugs which have kept full-blown AIDS from totally destroying the body's immune system.

Now, scientists are again talking about finding a cure or at least paving the way towards one.

BENKIRANE: We have a very powerful drugs against HIV and these drugs really do a great job in terms of suppressing the virus in the blood. We have about 15 years experience with these drugs, and we know they will not cure HIV. So I think one of the challenges is to try to understand why and try to develop new drugs that will make us able to cure the virus. We're talking about two types of cure: either the complete eradication of the virus from the body; or, just functional cure. What we mean about functional cure is actually to be able to stop the therapy without having viral rebound, so people can live without treatment.

Question: And central to the search for a cure, I understand is this modulator protein. Can you tell us about this modulator protein and how it works?

BENKIRANE: This is a different issue, this is more like related to the immune responses. So this protein that we actually identified is a protein that protects dendritic cells from being infected by HIV. So what are the dendritic cells? Those are the cells that normally initiate innate immunity and also orchestrate the adaptive immunities, specific immunity against a virus or an invader. The problem with this is that HIV escapes and is not sensed by these cells, so when these cells capture the virus, they do not do their job. What they do, however, because they capture the virus, they express the receptor and everything required for the binding and they take the virus up to the lymph nodes, where the virus likes to replicate the most, which are the activated CD45 T cells. Because these cells are the first cells that contact the virus during transmission,  what is aimed is  to actually make these cells able to sense the virus and one way to do that is to make them permissive to the virus. To achieve this, we have to identify the restrictions so that they operate in these cells and that is the SAMHD1 that we identified. The hope here actually is to see if we act on this protein, if we make these dendritic cells permissive to the virus, that will initiate innate immunity and they will also orchestrate a good and very early adaptive immunity against HIV which may lea d to a better control of the virus.

Question: Dr Benkirane, it's World AIDS Day. What is your assessment of the medical and scientific work that's been going on so far towards finding a cure? Thirty years on, is there global collaboration, are we moving forward?

BENKIRANE: Yes, there is global collaboration. I think there have been really great progress in HIV AIDS in terms of treatment, vaccine and prevention. I think the most important thing that we recently learned is that treatment is prevention, because people who are treated, people who are under suppressive drugs barely transmit the virus. I think this is some  really important information.

Now the vaccine field is moving very nicely, I think because of the recent Thai trial. I think it's the first time we have some hope. It's not going to beat that, but I think it's a good starting point. The other challenge that I think we're going to have to face is the cure, trying to develop a way to help the anti-viral therapy that we currently make, either to be able to eradicate the virus or at least have a functional cure.

London pastors put lives at risk with HIV 'cure'

A London church has been putting lives at risk by telling HIV-positive worshippers to stop taking their medication because God had "cured" them.

Undercover reporters posing as HIV sufferers were told they could be healed by pastors at the Synagogue Church of All Nations in Southwark.

After a "healing" process where the pastor sprayed water in their faces and shouted over them asking for the devil to come out, the "patients" were told they could discard their medication.

Sky News, which carried out the exposé, said at least six patients in the UK have died after being told by various churches to stop taking HIV tablets.

Jason Warriner of HIV and sexual health charity Terrence Higgins Trust said: "We're really worried to hear that individuals have been given false information about HIV treatments which, dangerously, put lives at risk.

"It's essential anyone living with HIV keeps taking the treatments that they've been prescribed by their health professionals to prevent severe ill health."
Former health secretary Lord Fowler, who led the HIV and Aids awareness drive in the Eighties, said the church's message was dangerous.

He said: "It is foolish advice and it is tragic advice because the consequences of this kind of advice can only be that people pass on HIV and can only be seriously bad for the individual concerned - including death."

Sky sent three undercover reporters to the church, where they said they were HIV positive and were told they could be healed.

They are filmed giving "before and after testimonies", which are put on the church's website.

One of the pastors, Rachel Holmes, told a reporter that if symptoms such as vomiting or diarrhoea persist, it is a sign of the virus leaving the body.

In a statement, the Synagogue Church of All Nations said: "We have not done anything to bring about healing, deliverance or prosperity. If somebody is healed, it is God who heals."

source: www.thisislondon.co.uk

How to beat the winter bugs

THE clocks have gone back and winter is on its way. As illnesses start spreading around work places and schools, it is likely that many of us will be struck down with some kind of ailment in the next few months.

But to try and avoid it there are a number of steps you can take to keep yourself as fit and healthy as possible.

Always eat plenty of fresh fruit and vegetables and try to exercise regularly and get plenty of sleep, says Dr Charlotte Jones, deputy chair of the British Medical Associations Welsh GP committee.

Wash your hands regularly to avoid the spread of infections and wipe down hard surfaces and handles regularly to kill off germs.

At this time of year, vulnerable people, including the elderly, should take extra precautions to keep themselves healthy.

Mathew Coffin, Ageing Well Team Leader at Age Concern Cardiff and Vale of Glamorgan, said: One of the most important ways to stay well this winter is to get the flu jab.

We recently did a survey about why people are not having it and many people already think they are fit and healthy so they would not have it. They feel they have never had a problem before and that the flu jab might even give them flu, which can’t happen as it is a dead virus. People often said they felt unpleasant side effects from the flu jab but it is often that they have caught something else at the same time.

People should always try to keep warm in their own home. Many people are turning down the thermostat because of rising fuel costs but we can give thermometers out that monitor the temperature, which should be between 18C and 21C.


Eating well is also important to stay healthy and people should make sure they stock up their cupboards. We have had a bit of snow in the last couple of years so people may not be able to get out and they work their way through their cupboards and don’t eat very well. Trying to stay active in the winter months will also help. We tend to stay inside during winter but some exercise will help.

Dressing well for warmth is also an issue. It’s almost common sense but we say that a few layers is better than just putting on one jumper. Wearing a hat can also help.

However, if you do succumb to viruses and other illnesses, Dr Jones has provided tips on ways to minimise your symptoms and get you back on your feet sooner rather than later.

She said: If you do get ill, don’t forget the catch phrase ‚catch it, bin it, kill it’. Sneeze or cough into tissues and bin tissues immediately.

Many of the winter ailments are due to viral infections. These are often unpleasant but don’t require antibiotic treatment as antibiotics are only effective with bacterial infections.

Also, many people are unaware that if they are given antibiotics wrongly,  they run the risk of getting antibiotic resistance. This means more difficult to treat infections that don’t respond to the usual antibiotics and can be a major problem.

Coughs and colds are often quite mild and tend to clear up within five to seven days. The main treatment for all viral illnesses is to drink plenty of fluids, eat healthily, rest and take paracetamol as per pharmacy or medical advice. Steam inhalation is helpful as it helps the nose drain. Honey and lemon can help with a sore throat.

Avoid sneezing over other people, in particular pregnant women and patients with immune problems or having cancer treatment.
If someone truly has flu it will make them very unwell. They will have a high temperature, all joints and muscles will be aching and they may be sweaty and clammy. The main treatment is to drink plenty of fluids, rest, try steam inhalations and take paracetamol or ibuprofen (provided they don’t have asthma or stomach problems) regularly.

If people are getting worse despite this or if they have breathing difficulties, then they need to seek urgent medical advice. People more at risk with chronic illnesses such as asthma or heart problems should always speak to their doctor or pharmacist for further advice.

Of course anybody who is eligible for the flu vaccine should make sure they get it before the flu season starts and should be booking themselves in now.

Sore throats are mainly viruses and very rarely require antibiotics unless you are having huge difficulty swallowing or not responding to pain relief or medicines to reduce your temperature. For patients aged over 16, gargling aspirin can help.

Around 90% of viruses should settle without antibiotics, but if it is getting worse rather than better, and the patient is having difficulty or severe pain on swallowing or not able to swallow their own saliva or a thickened voice then they might need further treatment and should seek advice.

Dr Brendon Mason, Consultant Epidemiologist at Public Health Wales, warned of a return of flu and winter vomiting bug norovirus this year and provided advice on what to do if you are unlucky enough to fall victim to them.

He said: Obviously eating five fruit and vegetables a day and exercise will help keep you healthy in general, but it won’t be a fool-proof barrier to viruses.

The two diseases that we tend to think about during winter are the winter vomiting disease and flu.

If you have either of these illnesses, do not go to work and do not let children who have them go to school. Anyone with diarrhoea should not go back to work for 48 hours after the symptoms have resolved. Most of us will try to stagger into work but it really is better to stay at home. Providing you are reasonably fit you can self-treat drink plenty of fluids and rest.

If you are ill, being well insulated and keeping warm is always good.

If you need medical help, you can get expert advice from the NHS, your local pharmacist, and your GP.