This summer's 19th International AIDS Conference, while acknowledging the still-great challenge of fighting the disease, was filled with talk of new battle strategies, such as early treatment and preventive drugs, and even hopeful discussion about research into a cure.A New Way of Preventing HIV
HIV remains a serious health condition and still claims lives around the globe, but several presenters at the Washington, D.C., event -- held in the U.S. for the first time in 22 years, with the end of the nation's ban on HIV-positive immigrants and visitors from abroad--offered ideas they say promise progress against the virus and its complications.
Among the more interesting:
Early Treatment Rules
One group of researchers unveiled new treatment guidelines that call for physicians to put HIV-positive individuals on medications as soon as they are diagnosed, instead of waiting until their immune system shows signs of deterioration (as measured by T-cell count), which has been a common approach.
The need for treatment does become more urgent as T-cell count decreases, said the researchers, but the availability of a variety of drugs and studies indicating the benefits of early treatment make it worthwhile to begin even before T-cell counts are affected. The team, led by Atlanta physician Melanie Thompson, recommends a regimen of Truvada or Epizom plus either Sustiva, Reyataz, Prezista, or Isentress.
These drugs can not only decrease the amount of HIV in the body, they can make it more difficult for an HIV-positive person to transmit the virus (although safer-sex practices are still called for). "The scientific community really recognizes how valuable they could be to prevent transmission," Rowena Johnston, director of research for amfAR, told HealthDay.
The idea of "treatment as prevention" also informed the discussion of Truvada's recent approval to be prescribed as a preventive measure for HIV-negative people at high risk of contracting the virus. Some conference attendees questioned the wisdom of using the drug for prevention, given its cost, the possibility of side effects, and the danger that people taking it may become lax about safer-sex precautions. Harvard University researcher and conference presenter Douglas Krakower said, however, that he considers it irresponsible "to withhold strategies that may be protective."Surprise Benefits of Antiretrovirals
Cost is likewise a consideration with early initiation of treatment, as is the need to stay on the drugs faithfully; breaks in treatment can lead to the development of drug-resistant strains of HIV. But one study presented at the conference documented a group of patients in France who were treated early, went off their meds, and have seen the level of HIV in their bodies remain low. These results provide still more reason that "antiretroviral treatment should be started very early after infection," said Charline Bacchus, lead researcher at the French National Agency for Research on AIDS and Viral Hepatitis.Is This the Final Farewell to HIV?
A report about two Boston men who had achieved undetectable viral loads after receiving bone marrow transplants received much fanfare at the conference. The men, who have both been HIV-positive for several years, received the transplants as a treatment for cancer, but the procedures also had the effect of making HIV undetectable in their blood. Their cases differed from that of the so-called Berlin patient, Timothy Ray Brown (pictured above), who also achieved viral suppression following a bone marrow transplant. His was with stem cells that had a genetic mutation with resistance to HIV; the other men's transplants involved cells without the mutation. Doctors at Brigham and Women's Hospital think the Boston men's HIV became undetectable because antiretroviral drugs, which they continued taking during the transplant process, helped keep the cells that repopulated their immune systems from becoming reinfected with the virus.
Both men remain on antiretroviral treatment, and doctors say it is too early to describe them as "cured" of HIV. Researchers plan additional studies, both to see if the men might have HIV in their tissues, if not in their blood, and to determine the effects of bone marrow transplants in other people with the virus. Brown, on the other hand, has been off anti-HIV drugs for several years and is what scientists consider "functionally cured." At the conference, he announced he has started a foundation that will conduct research into a cure.The Cure IS Coming
Others also have new optimism about a cure. The International AIDS Society, which sponsors the conference, has put together a strategy for seeking a cure, identifying key areas for research to make this possible. It announced the strategy just prior to the conference.
"The science has been telling us for some time now that achieving a cure for HIV infection could be a realistic possibility," said French scientist Francoise Barre-Sinoussi (pictured above), who helped discover the virus, in announcing the project. "The time is right to take the opportunity to try and develop an HIV cure -- we might regret never having tried."