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The brink of hyperbole

The brink of hyperbole 

The media has been at it again, claiming that a cure for HIV is imminent. But, as Miranda Smith reports, the headlines should be taken with a pinch of salt.

First up, some background: researchers from several institutions in the UK (including Imperial College London, and Oxford and Cambridge universities) are running a clinical trial. The Research in Viral Eradication of HIV Reservoirs (RIVER) study is trialling a two-pronged approach to reduce the HIV reservoir. It is a small study, aiming to include 52 people newly diagnosed with HIV.

In the trial, all participants will be given combination antiretroviral therapy (ART). Half of them will also receive additional treatments to reduce their HIV reservoir. The treatment consists of two separate HIV vaccines to boost the immune system, and a short course of an extra drug — vorinostat — to ‘wake up’ latent HIV. This strategy is described as ‘kick and kill’ (the vorinostat flushes HIV from its hiding places in the viral reservoir, while the boosted immune system destroys the newly woken infected cells). Researchers have created an animation to explain the strategy.

The Sunday Times in the UK reported that, having completed the trial, a 44-year-old man showed no sign of the virus in his blood. This, said The Times, put researchers on the “brink of a cure”.  Similarly, the UK Telegraph reported that a cure was “close”. Nearer to home, Brisbane’s Courier Mail linked to the story online with the following: “Man miraculously ‘cured’ of HIV”.

Let’s not run away with ourselves here. ONE man has completed treatment, and all we know so far, is that he did so safely. That he has no detectable virus in his blood is NOT evidence of a cure. Remember, he is on antiretroviral therapy and most people on ART do not have detectable virus in the blood.

The researchers have not yet looked at his viral reservoirs, and the full results of the trial are not expected until 2018. It is also important to note that the trial will not involve stopping antiretroviral therapy, so it cannot be known whether the participants are able to control the virus without the assistance of ART.

While the RIVER study is an interesting one to watch, any reporting at this stage is speculative at best. We should wait until the full trial results come out in two years’ time before starting to get overly excited about the discovery of a cure.

Full details of the RIVER trial, including the study protocol, can be found here.

More cautious (and realistic) coverage of the results can be read here and here.

Findings may lead to functioning cure

Described by researchers as “a complete first”, a new study suggests that an antibody treatment ‘cures’ monkeys of SIV (the non-human primate version of HIV). In the American trial, eight monkeys were given antiretroviral therapy (ART) before being infused with an antibody usually associated with treating Crohn’s disease (gut inflammation). 

More than nine months after the dual combination treatment had stopped, all eight monkeys had suppressed levels of SIV in their blood. In the animals that were given a placebo antibody, the virus returned to high levels within a fortnight of the halting of ART.

 “The results knocked us out — they were so stunning,” said Anthony Fauci (pictured), a leading immunologist who heads the US National Institute of Allergy and Infectious Diseases (NIAID).

The findings have led to predictions that the search for a cure for HIV will now swerve in a completely new direction. Professor Sharon Lewin of the Doherty Institute in Melbourne said the trial produced “very convincing data”. However, she admits researchers are baffled by the findings. “Whether it’s a quirk of the monkey model, we don’t know,” said Lewin. It’s also not known exactly how long the viral suppression will last.

In an effort to discover more, further trials will be conducted. Indeed, studies are already underway on people with HIV. “We’re going to find out very soon whether this is all a bunch of nonsense or actually works,” said Fauci.   

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