Scientists: In Tough Economy, AIDS Cure More Important Than Ever
As the economic recovery continues in fits and starts, funding for AIDS medications for those who could not afford the treatment is fast becoming an unsustainable expense. Scientists say that’s one reason why, thirty years into the AIDS epidemic, a cure is more urgently needed than ever, a June 1 Reuters article reported.
"Caring for HIV patients in developing countries alone already costs around $13 billion a year and that could treble over the next 20 years," notes the article.
Closer to home, some states have begun eyeing cuts to assistance for HIV patients who cannot afford the medication they need.
"We have to think about the long term, including a strategy to find a cure," Nobel laureate Francoise Barre Sinoussi, who won the prize for her work into HIV, told Reuters. "We have to keep on searching until we find one."
And though some still fear it’s too early declare him "cured," the case of an American who received a bone marrow transplant in Germany may point to the possibility of one day eradicating the virus from a living host. Timothy Brown had to stop taking his AIDS drugs when he received the transplant as a means of fighting off leukemia. Because the donor had a genetic mutation that made him resistant to HIV, that resistance seemingly transferred to Brown--and though Brown has not yet resumed his HIV regimen, there’s no sign of the virus in his system four years later.
That doesn’t mean there’s absolutely no virus there, just that whatever level of presence the virus may still have in Brown’s body is at an undetectably low level. Successful management of HIV often produces just that result. Even if he has not been "cured" in the sense of all viral presence being eradicated, the transplanted marrow may be acting in a similar fashion to anti-retrovirals, keeping any residual virus at low levels and preventing its replication.
Indeed, some--including Dr. Gero Huetter, the German physician who treated Brown--are optimistic that the benefit Brown has gotten from the procedure is not a transitory effect, the Reuters article reported.
"He has no replicating virus and he isn’t taking any medication. And he will now probably never have any problems with HIV," said Huetter.
The procedure that Brown underwent cannot be repeated for all people living with HIV. For one thing, Brown was lucky enough to find a match in a donor with the specific mutation that would act to suppress the virus. For another, the procedure is an expensive one, usually only undertaken as a last resort with cancer patients.
"It’s clearly unrealistic to think that this medically heavy, extremely costly, barely reproducible approach could be replicated and scaled-up," Sinoussi told Reuters, "but from a scientist’s point of view, it has shown at least that a cure is possible."
But if a cure for HIV is a goal worth pursuing because it might one day mean that infected individuals will no longer have to rely on daily doses of expensive medicine for years or decades--thus sparing governments the cost of providing for those who cannot afford the medicine--the prospect of taking money from those programs to fund research into how to eradicate the virus from those who have become infected alarms those who fear that today’s poor might be traded for tomorrow’s cure.
"Until recently, people in HIV and AIDS circles feared that to direct funds toward the search for a cure risked detracting from the fight to get HIV-positive people treated," Reuters reported. "Even today, only just over five million of the 12 million or so people who need the drugs actually get them ... for every two with HIV who get a chance to start on AIDS drugs, five more join the ’newly infected’ list" worldwide."
And the rate of growth is rapid: The article said that over 7,000 people contract HIV every day.
Generics help make treatment more affordable, keeping costs to around $150 in poor countries where they are available. (In the United States, annual costs for HIV medication can exceed $20,000 per individual, the article said.) But the days of cheap generics may be limited--and even as matters stand, $150 is a lot of money for many people in poorer countries.
"It’s clear that we have to look at another possible way of managing of the epidemic beyond just treating everyone forever," Australian AIDS researcher Sharon Lewin told Reuters.
That’s where the picture shifts back to Brown, only instead of putting the entire patient through the grueling treatment that Brown survived, scientists envision harvesting a patient’s own immune system cells, genetically altering them so that they are resistant to HIV, and then injecting those cells back into the same patient they came from. If enough genetically modified white blood cells could be put into circulation, an individual might acquire the same resistance artificially that the naturally occurring mutation conferred upon Brown’s donor and, seemingly, on Brown.
The alteration "works like scissors and cuts a piece of genetic information out of the DNA, and then closes the gap," Huetter explained. "Then every cell arising from this mother cell has this same mutation." Thus, it would not even be necessary to swap out large amounts of cells--just enough so that when they were reintroduced, they would populate the patient’s system with resistant cells via natural replication.
Another group of people under study are those who become infected with HIV, but who do not seem to need anti-retrovirals in order to keep the virus in check for long periods--their own immune systems, while unable to eradicate the virus, manage to keep it in check. Such individuals are known to researchers are "elite controllers," the Reuters article said.
But there’s a deeper problem that needs solving. HIV can lurk in the body, in an inactive state, for years on end. Current drugs can’t touch those deeply sequestered viral particles, which are also beyond the reach of the immune system.
Researchers theorize that with the right drug they might be able to activate those hidden viral particles--and then destroy them.
Some argue that while a cure would be a wonderful thing, prevention remains absolutely critical to combatting the epidemic. While infection rates have declined overall, in some demographics they remain disproportionately high. Young gays and MSM (Men who Sex with Men) of color, for example, still have high infection rates; AIDS activists speculate that a mixture of scientific ignorance and social stigma contributes to the spread of HIV. Men who have sex with men, for instance, may identify as heterosexual and marry women and then neglect or avoid HIV testing because they believe HIV to be a "gay disease."
Since the virus has no political agenda--it simply takes opportunities to infect people, regardless of race, socio-economic status, or sexual orientation--such beliefs do nothing to protect people against HIV, and may even translate into riskier sexual conduct and delays in treatment.
Such delays in themselves may worsen the crisis: An untreated individual poses greater risk of transmission to HIV- partners. Moreover, the longer an infected person delays treatment, the more damage the body suffers.
But universal education about HIV/AIDS has proven as elusive a goal as a cure for the disease.