Tue July 24, 2012
Researchers Renewing Focus On AIDS Cure
Originally published on Tue July 24, 2012 2:36 pm
NEAL CONAN, HOST:
Since the early years of the AIDS epidemic, talk of a cure became almost taboo. In the past few years, advances in prevention and treatment became increasingly effective. Now some researchers say it's time to shift focus and resources to finding a cure. So why now, what's changed, and how close are we? If you have questions about the search for a cure for HIV/AIDS, give us a call: 800-989-8255. Email us: firstname.lastname@example.org. You can join the conversation on our website as well. That's at npr.org.
Dr. Steven Deeks is a professor of medicine at the University of California, San Francisco, co-chair of the International AIDS Society's working group Toward an HIV Cure. He's in Washington for the International AIDS conference this week, just across the street. He joins us here in Studio 3A. Thanks for coming across.
DR. STEVEN DEEKS: You're welcome.
CONAN: And until recently, researchers - cure is - I think has been described as the C-word in the HIV context.
DEEKS: Yup. No, things have changed dramatically over the past couple of years.
CONAN: What's changed?
DEEKS: Well, I think there are three things that have happened. One, I think the community, the scientists, clinicians, treatment advocates, patients, have become to realize that the current approach, which involves controlling the virus, not killing the virus but controlling the virus, works great, but there are issues. In order to - for people to live a long time, they have to take these drugs every day, day in, day out, for decades and decades. And for lots of reasons: people, adherence(ph), toxicity, cost. It's just hard for a lot of people to do that.
And so we're thinking that rather than simply controlling the virus, we'd like to go in and kill the virus and get rid of the virus. So that's the first thing. There's a strong motivation to do this. Real quickly, the two other things that have happened have been that the science has advanced to where we think it may be possible. And, of course, there is the so-called proof of concept, Mr. Timothy Brown, the Berlin patient, well-known to many, who underwent a very aggressive bone marrow transplant about five years ago...
CONAN: And nothing to do with his HIV.
DEEKS: No, no. So the - Mr. Brown, the Berlin patient, was doing well on therapy about five years ago, developed leukemia, and underwent a bone marrow transplant that was a little bit unique. And as a consequence, he appears to be cured.
CONAN: And this, again, discovery completely off-kilter from any research that anybody was doing, but it does show promise?
DEEKS: It depends on what you mean by promise. This is not something that's going to happen many times in the future. What Mr. Brown went through was complicated. He almost died on a couple occasions. He was in and out of the hospital for a few years. It's not the kind of thing you want to do for your HIV. It was done for his leukemia. But they just did this little twist in the procedure. Rather than transplanting bone marrow from a typical person, they found bone marrow from these very rare individuals who are naturally resistant to getting HIV. And they transplanted that bone marrow into Mr. Brown. Mr. Brown stopped his drugs. The virus never came back.
CONAN: And there are others - there are two elements to this, as I understand it. There are others who have been found with at least one element, and they seem to be more resistant than most to HIV.
DEEKS: So you're talking now about other transplants?
CONAN: No, not other transplants. People who have this condition naturally.
DEEKS: Oh, yes. No. So there is. And we've known this for a couple of decades now, that there is a small subset, maybe about one in a hundred people, who were born with the capacity not to resist the virus but to control the virus. These people are referred to, unfortunately, as elite controllers. I mean, that's sort of the name that stuck. They sort of are the best in terms of what happens in long-term HIV infection. But they acquire the virus. The virus is there. It can replicate. It's a bad virus, but their immune system somehow takes over and controls it and controls it indefinitely.
And we've known about this for quite some time, and we think it's because they have these very powerful so-called killer T-cells that are able to identify the virus and kill it. Problem has always been that we've never been able to find a way to translate that information into other people. We've never been able to use that to come up with a new clinical strategy for cure, for treatment purposes.
CONAN: And does the Berlin patient, does Timothy Brown, does he offer the prospect, this avenue of developing something that is, as you say, less risky than a bone marrow transplant?
DEEKS: Well, the trick with Mr. Brown is that the stem cells that were transplanted lacked something called CCR5. CCR5 is the door by which the virus gets in the T cells. There are a number of groups that are coming up with novel ways to get rid of CCR5 genetically. And there's one group in particular - a couple groups, actually - who have developed these so-called molecular scissors that actually go into the cell, cut up CCR5, and in theory, could, in a much safer way, do for someone else what happened to Mr. Brown. But that's years off, and it's not sort of science fiction now. But at least there is a pathway by which I think we can get there.
CONAN: And as you know, one of the reasons the C-word, cure, was avoided for so long was a concern that if people were talking about a cure, other people may say: Oh, cure? I guess I can go back to the kind of risky behaviors that got people this disease in the first place.
DEEKS: You know, I think that's what people were concerned about, and that was a concern in late '90s, when these first studies first started occurring. But to be honest, I don't think that's played out. I think most people who are involved in this effort realized that this is maybe not a pipe dream anymore. It's a possibility, but it's a far way off. And at the end of the day, it's almost always going to be better to have never gotten HIV than to have gotten HIV, dealt with the virus for a while, and then gotten cured.
CONAN: And one question about resources: Is this search for the cure - how much is going - being devoted in terms of money, in terms of medical research? And is this - could this, some people say, be a distraction from other efforts for prevention and treatment?
DEEKS: This is always an issue. The NIH, which has been the largest funder of this type of research in the past, their budget has been basically flat for many years. But despite the fact that their budget has been flat, the NIH leaders have been able to identify, actually, I think a good amount of funding for this work, about $50 million last year for cure work. And this happened very quickly. And this happened without any controversy.
I think that the field in general has recognized that this is worth the investment, and so this money has been shifted around from research and other areas into cure work without much of a controversy. And I think that's all good. And the hope is, is that in the future, we will be able to identify more funding within the NIH, but preferably without - outside the NIH, novel areas of funding.
CONAN: Our guest is Dr. Steven Deeks of the University of California, San Francisco on the International AIDS Society's working group Toward an HIV Cure. Let's get Curtis on the line. Curtis is on the line with us from Sacramento.
CURTIS: Yeah. Doctor, the question I had was the relationship between the Berlin patient and the early diagnosis of AIDS as gay leukemia. Symptomatically, is that relationship maybe what might be helping the Berlin patient with his success? And then that brings me to a second question, which is: Is it possible that there are two different types or strains of AIDS that one treatment might work for and others may not?
DEEKS: Well, the HIV can cause certain types of cancer. It's not necessarily leukemia so much as lymphoma. But I'm not sure that the connection between the early error in how HIV was discovered and today is relevant. Now, with regard to strains, one of the key problems we've always had with HIV is that there are many, many strains within - even with an individual, the virus evolves and changes and so forth. And yes, it certainly is possible that some of the interventions that we're presuming will work for some virus families or strains and not others, but we're not there yet.
CONAN: Thanks for the call, Curtis.
CURTIS: You're welcome.
CONAN: Let's go next to - this is - and we're trying to get the - all right. Well, I'll deal with that in just a minute. As you look down towards this pipe dream - this possibility, no longer a pipe dream, but a possibility, what do - does the outlines of a cure look clear to you?
DEEKS: Well, there are two broadly defined ways to go about this. One is to do the gene therapy stuff. And to be honest, that's the most promising. I think that there is enough progress - the Berlin patient, new ways to go with gene therapy - that we could, if we really wanted to, cure more people with this aggressive way. And that's moving forward. But what people really want, what's going to really change the whole world in terms of HIV is something that is more affordable, that's safer, that's scalable, that could be done in my hometown, San Francisco, as well as in rural areas of Africa and elsewhere.
Now, what would that look like? We don't know yet. It's just beginning. But in theory, a strategy that involves, number one, getting the virus out of its hiding place. The reason we can't cure things now is because the virus hides in these cells, and no one can get to it with the immune system or drugs. So the first thing will be getting the virus out of its hiding place. And there are some really exciting data coming out in the next couple of days about that approach.
And two, to come up with a way to kill not the virus so much, because current drugs that we do take care of the virus when it comes out, but to come up a way to kill the reservoir, the cells that contain this hidden virus. And we'll do that once the hidden virus becomes unhidden with these approaches.
CONAN: Let's see if we get that caller in on the conversation now. Let's go to - and there we go - Mark, and Mark is on the line with us from Kokomo, Indiana.
MARK: Kokomo, Indiana, born and raised, and then I moved to San Francisco, California, North Beach/Telegraph Hill and recently moved back to Kokomo, Indiana. So I basically - I just have a comment, being one who's gone from an ultra-liberal environment back to a die-hard conservative, religious environment. What I've learned, sadly, is that the attitude around where I live is that there should not be one dime spent on the research with the goal of finding the cure. This is 100 percent preventable, that (technical difficulties).
CONAN: And I think your cellphone, Mark, is betraying you. But, well, Dr. Deeks, AIDS is a preventable disease.
DEEKS: In San Francisco, there is a tremendous amount of public health interventions and resources that have been poured into trying to prevent the transmission of HIV. It's a highly educated group of people there. There's all these resources. And essentially, the amount of transmission that occurs within our community and within communities around this country have basically not changed. There are fundamental reasons why we think just with the current strategies, it's not going to work in terms of prevention.
Now, probably the best way to prevent HIV from being passed around is to get rid of the reservoir, you know, get rid of where the virus is coming from. And we could do that in two ways. We could treat everybody with current therapy. If we treat people with current therapy and they take the drugs, they are less likely to pass the virus on to other people. And this is one of the great things about treatment. It actually works for prevention. But a cure, in theory, would do the same thing.
CONAN: And that treatment, treating everybody, the current price, I think it's about $1,000 a month.
DEEKS: Well, that's about $1,000 a month in resource-rich areas. It's much, much less expensive in resource-poor areas.
CONAN: And that's because?
DEEKS: Oh, that's because the drug companies are donating the drugs, things like the Clinton Foundation have come up with resources to basically enable this to happen. I'm not exactly sure how much it cost to treat people in Africa, for example, but it's far less - far, far less than what you just said.
CONAN: Well, Dr. Deeks, thanks very much, and we all wish you the greatest success. Dr. Steven Deeks, professor of medicine at UCSF. He took a break from the International AIDS Conference to come and speak with us here in Studio 3A. And you're listening to TALK OF THE NATION, from NPR News. Transcript provided by NPR, Copyright National Public Radio.