Do We Have a Functional Cure for HIV Yet?

With recent advances and successes, we are all optimistic about what the future may hold for us all in this fight against the AIDS epidemic, but we are also far from the final successful chapter of our battle with HIV.
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When HIV was first discovered in 1983 to be the cause of AIDS, patients and doctors alike felt the full brunt of the fear associated with a newly-discovered lethal contagion. Today, almost two and a half to three decades later, we seemed to be on the brink of having found a functional cure for HIV. To this potential triumph, we must be proud of what our minds and technologies are capable of. However, the battle has just begun, and much still needs to be elucidated before we can do our well-deserved victory dance.

At the initial forefront of confronting and tackling the AIDS epidemic, doctors traditionally focused on prevention of HIV by finding ways to protect people not yet exposed to it via education, potential vaccines and using treatments to suppress viral activity to prolong life expectancy. With recent stem cell research, it seems possible that a "functional cure" to HIV may very well be in the horizon for us all.

There was a case of a patient treated in 2007 and 2008 with bone marrow stem cell transplants with anti-inflammatory post-transplant treatment regimen, where HIV in his body has been suppressed to a level where it has been undetectable for three years. This has prompted renewed hope for a "functional cure" for HIV from this new angle. It gives researchers, physicians and patients alike a renewed hope for a possibility of a "cure." This comes after many years of persistence toward other treatment "cures" with many significant strides forward, but also, unfortunately, some haltering strides as well. Nevertheless, in order to procure eventual success in this fight against the AIDS epidemic, we must learn from our mistakes and glean what we can from our successes until a "cure" is obtained.

In a prior case, another patient was given bone marrow stem cell transplant from a baboon, a species naturally resistant to HIV, but that patient passed away from complications of AIDS after transient improvement of symptoms. Similarly, with the advent of highly-active antiretroviral therapy (HAART) medication regimens, patients were able to achieve significantly suppressed viral levels. But we soon realized that the virus can remain dormant in many cells only to reactivate later on, therefore realizing that HAART was not a "cure." In the interim, other treatment ideas have been entertained in hopes of achieving this elusive "cure."

The concept of shock and awe also has been tossed around as a way to drive dormant HIV virus in cells outward to be treated and destroyed by HAART regimen. But, many questions still remain regarding this concept because we are still unclear as to where all of the viral population might remain dormant, and whether activation of the dormant virus might precipitate decline and activation of disease symptoms in patients beyond what is desirable. With so many questions still remaining, the key concept to focus on is that with each new hypothesis of potential "cure" options, we are finely sifting through the information we need to take the necessary steps toward finding the solution for eradication of this far-reaching global disease epidemic.

And after all those prior attempts and various perspectives, it has led us to the most recent strides toward the ideology of finding a "functional cure" for HIV. The terminology of "functional cure" indicates the potential eradication of viral activity from all tissues in body, whereby the virus is suppressed enough by our own enhanced immune system such that the virus stays permanently in check. If we are able to achieve this, the concept of temporizing medication therapy may be dispensable altogether.

For the patient who received the stem cell transplant in 2007 and 2008, his case is being intricately evaluated to see what factors in his history may be replicable in other patients and what key steps within the process ensured his "functional cure." This patient was transplanted with the stem cells from a donor who was resistant to HIV because the CCR5 surface co-receptor protein is missing in these cells; thus, leaving the HIV virus unable to enter cells. Although HIV also could use another receptor CXCR4 to enter cells, it is still unclear why it did not occur in this patient.

There is some suggestion that perhaps the anti-inflammatory medications given to this patient after transplantation may have helped the process because the cellular damage of HIV infection also rests heavily on a chronic inflammatory process. So, it remains to be seen as to whether a strong anti-inflammatory treatment regimen in combination with such a stem cell transplant may be the way to go for a more universally successful "functional cure."

Whichever way a potential treatment and "cure" regimen might be, we should still be fully cognizant that prevention should always be an important concept to practice in medicine. The concept of prevention should always remain at the forefront of our thoughts. With most viral infections, we should always be wary of viral mutation, which could potentially thwart our attempts at "functional cures."

The exact necessary comprehensive regimen to be able to consistently achieve a "functional cure" for all HIV patients still remains to be clarified. The final conclusion of a universally successful "functional cure" may indeed be a combination of prior regimens with that of a stem cell transplant plus a potent anti-inflammatory regimen.

With recent advances and successes, we are all optimistic about what the future may hold for us all in this fight against the AIDS epidemic, but we are also far from the final successful chapter of our battle with HIV. Therefore, however hesitant and haltering our strides may be at times, the key is to make sure that those strides continue to confidently move forward for the benefit of future generations to come.


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