It may be next to impossible to imagine a world without HIV, but it’s getting closer to one where HIV will be in remission, says French retrovirologist and Nobel Prize winner Francoise Barré-Sinoussi.
The goal is to eliminate the need for life-long antiretroviral treatment of HIV-infected individuals, and though this may not mean that the virus is completely gone, it would mean that the immune system would be able to keep any residual virus in check and that there would be no risk of transmission. “We have proof of concept today,” says Barré-Sinoussi, who’s in Boston this week, where she delivered the keynote address at theKeystone Symposium: Mechanisms of Persistence: Implications for a Cure.
Barré-Sinoussi, one of the co-discoverers of HIV and past president of the International AIDS Society, called for more research into the latent reservoir of HIV that serves as the main obstacle to curing people infected with the virus. The viral reservoir is the pool of latent HIV-infected cells hiding out in blood and tissues such as lymph nodes, the gut, and the brain.
“Why do we need new therapeutic strategies?” Barré-Sinoussi asks. “In patients on treatment, if they stop treatment, you have viral rebound. This rebound is due to the reservoir of the virus. So we have to better understand the science around the reservoir.”
This will likely be a tough task. Barré-Sinoussi cites research published last year from Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, which shows that following SIV infection of monkeys, the reservoir is rapidly seeded—within a few days—after the initial infection. “It is an almost impossible mission to totally eliminate latently infected cells,” she says. “I used to say that in my language, in France, we say ‘impossible is not French.’ We still have to continue and try to succeed.” But for now, she thinks remission is a safer bet. “Remission, in my opinion, is possible,” says Barré-Sinoussi.
How to understand and deal with the viral reservoir is a dominant theme in Boston this week but there are others. Some 330 researchers and students from 31 countries are in for the symposium, many travelling a long way to get a closer look at the state of the art in HIV cure research. Two researchers from the Walter and Eliza Hall Institute in Melbourne, Australia, came to pay special attention to the suppression of cells infected with HIV but lying dormant. Cody Allison, a postdoctoral fellow on Marc Pellegrini’s team in the division of infection and immunity, was on hand to discuss a strategy related to the “shock and kill” approach, which involves luring HIV from its hideouts and then using various strategies to eliminate it. Shock and kill strategies are another prominent topic for the week.
Olivier Lambotte of the University of Paris South is another member of the strong French contingent of scientists pursuing cure research in recent years. He’s already pleased with the meeting so far. “If we want to find a cure for HIV,” he says, “we need, absolutely, to speak together and exchange our points of view. And to think differently.” - Michael Dumiak