Over the past 40 years incredible advances have been made in the development of effective HIV treatments that allow people living with HIV to suppress their virus to undetectable levels and avoid transmitting it to others. This era of effective treatment with antiretrovirals (ARV) is undoubtedly a gigantic leap forward from the early beginnings of the HIV crisis, but the fact remains that there are almost 38 million people living with HIV (PLHIV) worldwide.
These individuals still have to take a lifetime of treatments, which can take a significant emotional and physical toll. To lift the substantial burdens of daily treatment and social stigma associated with HIV, a cure is essential towards accomplishing our goal of ending the HIV epidemic.
With this goal in mind, we are in pursuit of a cure for HIV:
HIV experts discuss ViiV Healthcare approach to HIV cure
The challenge of curing HIV
Because of the nature of HIV, discovering a cure comes with some specific challenges. The most significant of these challenges is the virus’s ability to hide itself and lay dormant in pockets of host cells that are unrecognised as harbouring HIV by the immune system. Even if an individual has successfully suppressed their HIV through ARV treatment, the hidden HIV, called the “latent reservoir,” can re-emerge if ARV treatment is stopped.
Richard Dunham, Director of HIV Cure at ViiV Healthcare
Induce and reduce: our approach to HIV cure
HIV is a sneaky virus that can persist in a small population of cells even while it’s spread to new cells is being suppressed by ARVs. Unless we can find a way to expose hidden HIV and selectively target these cells, we’ll continue to require chronic treatments to keep the virus at bay. Our current cure research is looking at how to target these pockets of virus through the concept of 'induce and reduce'.
This strategy is first focused on driving HIV hidden in human immune cells to make viral proteins that allow the cells with HIV to be recognised (Induce). Once cells harbouring HIV are exposed, drugs can then tag these reservoir cells for elimination by the host immune system (Reduce). The Induce and Reduce agents will all be given while people are on suppressive ARV therapy to protect healthy cells from the virus. While it may sound straight forward, it has been a major challenge to reactivate the virus in animals or people in an effective and safe way.
New pioneering research on the induce strategy was published in the journal Nature. This research summarised a scientific breakthrough in our efforts to push the reservoir virus out of hiding in two HIV animal models. For the first time, using a class of drugs new to the HIV field known as IAP inhibitors (Inhibitors of apoptosis), a signalling pathway in cells was activated that could induce the hidden HIV to reactivate and become visible, while having relatively few other effects on the healthy cells.
The success of this initial research was heralded as "amongst the top ten most remarkable discoveries of 2020" by the journal Nature and led to a novel programme that is progressing towards clinical studies in humans. At the same time, our researchers are also focused on developing companion molecules that will target cells with the newly exposed HIV to reduce the reservoir. If successful, the advancement of these molecules in combination could provide one of the strongest paths forward to curing HIV.
The research required to develop an HIV cure is complex and requires a commitment to the long-term. As we look ahead to the future, we’re optimistic that the initial steps we’ve taken towards establishing our approach to HIV cure will move from the laboratory into clinical studies in people, big steps in the long journey to finding a cure for HIV. It is our life’s work to end the HIV epidemic, and we will be here until HIV isn’t.
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