WILL HIV BE CURED ? WHEN THERE WILL BE NO HIV INFECTION AND IF SO TREATED COMPLETELY ? WILL ANY VACCINE COME FOR HIV ?
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These questions are widely prevalent starting from a common person to scietist and policy maker all are puzzled WHAT A DISEASE HIV-POWERFUL THAN ANY ONE EVEN EBOLA as no cure present ONCE A DISEASE MEANS DISEASE FOR LIFE AS NO CURE PRESENT ONCE MEDICINES STARTED THEN HAVE TO TAKE LIFE LONG,SEcONDLY ONCE CONTACT or even cured,even blood report showing no virus but disease may reappear if medicne stopped for long SO HIV virus hides somewhere and from there it cannot be traced by simple or complex blood examination THIS HAS MADE HIV A SERIOUS DISEASE FOR PATEITN,DOCTOR,RESEARCH SCHOLAR AND POLICY MAKER AS it cannot be eradicated,VIRUS mutate so rapidly as effective VACCINE HAS NOT COME AND MAY COME OR NOT NO ANSWER IS PRESENT.
We have plenty of data telling us we can make progress," said Françoise Barré-Sinoussi, PhD, of the Institut Pasteur in Paris. "How many years will we need? We don't know."
The passage, near the end of a press conference on cure research at the International AIDS Conference, illustrates a conundrum: Talking about an HIV cure is the only way to achieve a cure, but it also has the potential of raising false hope.
Barré-Sinoussi should know. She won a Nobel Prize as a co-discoverer of the virus that causes AIDS. And she is president of the International AIDS Society. And she is one of the driving forces behind the return of the word "cure" to the HIV/AIDS lexicon.But she's not foolish enough to give a timetable. She recalled predictions in the mid-1980s that a vaccine would be relatively simple to design. As of now, of course, there is still no vaccine even close to clinical availability..
Before the AIDS meeting, Deeks, Barré-Sinoussi and more than 200 others gathered for a symposium on cure research. A look at the program is illustrative -- this is science at its most basic. Which cells are targets? How do they work? Are there antibodies that can be manipulated? How? What cells can harbor latent HIV? Can they be located and destroyed?
Perhaps most basic of all questions is: What do we mean by cure?
It's simple enough in some circumstances, says Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.
In bacterial pneumonia, you give antibiotics, the pathogens die, the lung x-ray clears, the symptoms resolve, and the patient goes home cured. In some cancers, you have to wait a while to be sure that treatment has worked, but eventually -- after five years of remission, say -- you can say the patient is cured.So an HIV cure comes down to two possibilities, he told delegates here -- eradicating the virus or driving it so far underground that people don't need therapy, even if the HIV is still lurking somewhere.
With HIV, we don't know how to eradicate the virus. We don't know all its hiding places. And we don't have good tools to measure it even in the hiding places we know about.
One of the most talked-about studies here suggests it might be possible, using a cancer drug, to kick HIV out of some of its hiding places. But the very small and preliminary study, importantly, did not demonstrate eradication of the virus or even a noticeable reduction.
Take, for instance, the Mississippi child, who was HIV-positive at birth, was treated very quickly with anti-HIV drugs, and was on them for 18 months until she was lost to follow-up and was not taking the medications.
Strikingly, when she returned to a doctor's care, there was no sign of HIV -- a state that lasted for 27 months. Her physicians and other researchers wondered if the very early treatment might have prevented HIV from getting a foothold in her body -- the so-called viral reservoir.
It's that viral reservoir that makes HIV so hard to cure. Powerful drugs can stop the virus from replicating and eventually causing AIDS. But they cannot root out virus hiding in the reservoir cells.So, if the medications are stopped, the virus almost inevitably roars back within days or weeks.
But not in the Mississippi case. The child was off drugs for 27 months. Then, just a few weeks before this conference began, the child suddenly had HIV in her blood.The virus was back, although the remission was "unprecedented," according to Deborah Persaud, MD, of Johns Hopkins University, the lead researcher.
Sensitive tests could find no latent virus. Where was HIV hiding?
What triggered the rebound?
Answers might point the way toward duplicating the remission. To investigate, Persaud and colleagues are planning a clinical trial -- dubbed IMPAACT P1115 -- that will treat HIV-positive babies within 48 hours of birth.it means there's very little time to prevent HIV from digging in and hiding so hit virus before it can hide as detection in Blood means a lot of viremia,a too late.
same way it is not sure the Visconti patients are in remission. It follows that it's hard to see how to translate their experience into anything broader is not known..
The obvious answer -- treating everyone in the first acute stage of infection -- won't work. Even in developed countries, where it's possible to get treatment swiftly, most people's diagnosis occurs when their disease is already advanced and their immune system is in disarray.
The single case of apparent cure -- many people are waiting for the other shoe to drop, of course, -- is the so-called Berlin patient, Timothy Brown.
Brown had been on antiretroviral therapy for HIV when he developed acute myeloid leukemia. His physicians sought a stem cell donor who had two copies of an HIV-specific mutation in the gene for the chemokine receptor CCR5.
The mutation -- dubbed delta32 -- confers resistance to HIV infection; people with two copies are naturally almost immune to the virus.
After a successful transplant -- it took two tries -- Brown recovered from the leukemia and (as his doctors had hoped) his new immune system was resistant to HIV. He remains off HIV therapy today.
In principle, that's a pathway to a cure. But, Fauci pointed out, it's also an "n of 1" -- a single case -- and it's also not something you would try on a wide scale.
A stem-cell transplant is expensive and dangerous, with associated mortality of about 20%. It couldn't be rolled out to millions of people in sub-Saharan Africa, for instance.
But the idea of trying to use the delta32 mutation as either therapy or cure has caught on and several groups are trying to use gene therapy techniques to duplicate the Brown case without resorting to transplant.
Again, though, it's hard to see how such methods could be used on the necessary scale, in a world where some 35 million people are living with HIV.
Indeed, Fauci noted, a successful cure for HIV would have to have three characteristics.
It would have to be simple and easy to administer, with no need for tertiary care. It would have to be at least as safe as the antiretroviral therapy it's intended to make obsolete. And it would have to be scalable and affordable enough to treat those millions of people.
It is -- like an HIV vaccine -- a very tall order.