LivingCloser to a functional cure for HIV

Closer to a functional cure for HIV

A new study led by researcher Barbara Ensoli of the National Center for HIV / AIDS Research of the Istituto Superiore di Sanit√† in Rome (Italy) and published in the journal Frontiers in Immunology , suggests new ways to cure HIV: the administration of the vaccine Tat to people living with HIV on antiretroviral therapy drastically reduced the “latent virus reservoir,” which is invulnerable to anti-HIV drugs.

“These results open new perspectives for a functional cure of HIV, that is, the ability to control the virus during the suspension of antiretroviral drugs,” explains Ensoli . A functional cure would facilitate long-term clinical management of people with HIV by reducing the cumulative toxicity of antiretroviral drugs while improving adherence to therapy and quality of life that are crucial, especially for children and adolescents.

Almost 40 years after the virus was discovered, HIV / AIDS remains a global emergency, particularly for the world’s poorest and most vulnerable populations: women and children, homosexuals, bisexuals and transgenders (LGBT), sex workers, migrants and users. injection drug use.

To date, almost 40 million people in the world are living with HIV infection , half of them without any treatment, and international agencies are calling for a renewed effort, more investment and innovative strategies to find a cure for HIV and eradicate the virus.

It requires a strict and constant commitment to therapy, a lifelong responsibility to control HIV; in fact, the virus hides in the “virus reservoir” as a silent viral DNA invisible to the immune system and antiretroviral therapy (ART), but reactivates once therapy is stopped.

Now, the newly published research that had an 8-year follow-up period presents data from the long-term clinical examination of 92 volunteers who completed the trial in Italy and enrolled in the extended follow-up. The 8-year study was conducted in eight Italian locations: Hospital San Raffaele in Milan, Hospital L. Sacco of the University of Milan, Hospital San Gerardo in Monza, University Hospital of Ferrara, Polyclinic Hospital of the University of Modena, Hospital Santa Maria Annunziata in Florence, the San Gallicano Dermatological Institute in Rome and the Polyclinic Hospital in Bari. “The results suggest new pathways towards a ‘functional cure’ and, in perspective, the eradication of HIV,” says Ensoli, leader of the work.

The work shows that volunteers vaccinated with Tat after having been on antiretroviral treatment for an average of 6 years, experienced, for the next 8 years, a continuous decrease in viral DNA in the blood, which occurred at an average rate of 4 to 7 times higher than that observed in similar studies in patients treated with antiretroviral therapy alone.

Furthermore, in vaccinated volunteers, the reduction of the virus reservoir was associated with a very small deposit of latent viruses (as evidenced by low levels of proviral DNA in the blood) and a good recovery of the immune system (as indicated by a high CD4 + / CD8 + lymphocyte ratio).

Therefore, it is conceivable that vaccination with Tat may give patients the ability to become post-treatment controllers, that is, to control the virus without taking medication for periods of time the duration of which will be evaluated using specific clinical criteria. of the study led to programmed and controlled interruptions of therapy in volunteers treated with ART and vaccinated with Tat who are currently being treated in order to verify this hypothesis “, Ensoli sentence.

Reference: Continued Decay of HIV Proviral DNA Upon Vaccination With HIV-1 Tat of Subjects on Long-Term ART: An 8-Year Follow-Up Study Fabrizio Ensoli, Barbara Ensoli1 et al. Frontiers in Immunology 2019. DOI: https://doi.org/10.3389/fimmu.2019.00233

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