Is there a cure for HIV/Aids? Latest advances in HIV treatment in India

Click to know more on Antiretroviral therapy (ART) and other treatments for the management of HIV and whether HIV is curable.

World AIDS Day is on December 1st

Most of us know that HIV is a debilitating disease that is prevalent worldwide. When you or your loved one has been diagnosed with the infection it might take a great deal of time and understanding to accept it. And when the fact really sets in, you may run from pillar to post trying to find a cure. With many people out there claiming a cure, it s only wise to be well-informed about the illness and its cure, if any.

What is HIV?

Human Immunodeficiency Virus (HIV) is a viral disease that affects the body s immune system. The virus is transmitted from an HIV-positive person through the exchange of body fluids during sexual contact, blood transfusion, needles, or from a mother to child during pregnancy, delivery or breastfeeding.

But acquiring the virus doesn t necessarily lead to an infection. The mucosa (membrane lining body passages that lead to the outside) that comes in contact with the virus may be vulnerable, but not defenceless. They prevent the entry of the virus into the body. Even if the virus manages to pass through it, the immune cells beneath destroy it. Overcoming these defences,which usually lasts from one to three days, also doesn t guarantee an HIV infection. Once the virus spreads to other parts of the body through the blood and lymphatic system, the immune cells in them may kill the virus even before it can establish a permanent infection. But once the HIV manages to cross these barriers it infects one type of immune cell (CD4 cells) and make copies of itself to release more viruses. When the replication is faster than the defence from immune cells, the HIV infection may become permanent. The infection weakens the body s immune system. Read about HIV diagnosis 5 tests to detect a recent HIV infection

AIDS is the final stage of HIV infection. If an HIV positive person is left untreated, his/her condition deteriorates into full-blown AIDS where the immune system stops working due to serious loss of immune cells making him/her susceptible to various kinds of infections.

Are there any measures to prevent HIV acquisition/infection from an infected partner?

1. Condoms: Till date, condoms are the most reliable preventive measure against HIV.Correct and consistent use of condoms can protect against the spread of HIV.

How does it work: The male condom prevents semen from entering the vagina. The female condom creates a barrier by lining the entire length of the vagina.

Cost: a pack of three male condoms cost Rs 25, female condoms cost Rs 100

2. Pre-exposure prophylaxis: Pre-exposure prophylaxis (PrEP), to be used with other prevention options such as condoms, can be effective in preventing an acquisition from an infected partner. It consists of taking a fixed-dose combination of two antiretroviral drugs emtricitabine and Tenofovir consistently as a pill every day by the HIV-negative partner, after consultation with a medical expert.

How does it work: Blocks the virus and prevents it from spreading in the body

Cost: Rs1400/30 tablets

3. Post-exposure prophylaxis (PEP): In post-exposure prophylaxis (PEP),antiretroviral drugs are used after a single high-risk event within 72 hours of exposure to HIV in order to reduce the chance of an infection. It is recommended for health care workers with needle prick injuries in the workplace. Counselling, first aid care and HIV testing are also done. A 28-day course of antiretroviral drugs with follow-up care is advised depending on the level of risk.

How does it work: Stops the virus from making copies of itself to check it s spread throughout the body

Cost: Rs3000/30 tablets

What is the treatment for HIV/AIDS?

Interventions are available that are aimed at either helping the body s immune cells in the mucous membrane and tissues destroy the virus before it spreads throughout the body or drastically decrease the level of virus in the body. Pre-exposure prophylaxis may block the virus and prevent it from spreading in the body.

Antiretroviral treatment (ART) has proven to be very effective in reducing the progression of the virus in the body to a near halt. The therapy involves the use of at least three antiretroviral drugs togetherand must be taken at the right time every day, for life. ART can help people live longer, healthier lives and substantially reduce the risk of transmitting HIV to others. Read about 12 diseases that affect people with HIV/AIDS

How it works: Stops or interferes with the reproduction of the virus in the body and stop its progression to AIDS. Keeping the virus under check helps strengthen an individual s immune system to fight off infections.

Cost: Depends on the dose and regimen used, which in turn depends on the age of the patient &treatment status (whether it is the first line regimen, the second/ third/ salvage regimen)

Drawbacks:

• The virus can still replicate at low levels and accumulate in a latent form in what are called reservoirs
• Lifelong therapy requiring stringent adherence to treatment on a daily basis with regular follow up
• Risk of cumulative toxicities from longstanding therapy
• Difficulties in adhering to drug regimens
• Intolerance to certain drugs

Is there a cure for HIV?

Though there is no cure yet, HIV has transformed from a death sentence to a manageable illness. Major steps have been taken against the virus in the last 30 years even as we look to achieve a complete cure for HIV. In an attempt to find cure for HIV the focus has shifted from blocking the virus from replicating to essentially getting rid of the virus. Scientists have been investigating where and how the virus hides in the body and studying the immune system response of people who are naturally immune to the virus. They are using one of the two methods in order to achieve cure from HIV either flush out and kill the dormant HIV hiding in the cells and tissues with drugs or allow the patient s body to resist HIV by modifying his/her DNA.

Till date, only one person has been cured of HIV. And the very particular case of Timothy Brown aka the Berlin Patient, an HIV-positive man who developed leukemia, has given hopes of a HIV cure. After first line cancer treatments failed in him, a bone marrow transplant from a donor with an unusual gene mutation that resists HIV was done. Two transplants later, not only was his leukemia in remission, his immune system actually managed to ward off HIV. Brown no longer takes antiretroviral drugs or tests positive for HIV. Though promising, it comes with glitches. The fact remains that bone marrow transplants can never become a widespread procedure. Finding an appropriate donor is very hard and therefore alternatives are needed.

With these latest advances and alternate approaches which are under development and clinical trial stages, scientists are optimistic that a cure is in the offing:

HIV vaccines

Research is on to develop vaccines that are preventive or therapeutic (that boosts the patient s immune system, thereby increasing the effectiveness of his/her antiretroviral therapy).

Modified HIV virus to prevent AIDS

During a research, a scientist has developed a way to use HIV to beat HIV in the laboratory. He invented the Nullbasic protein by mutating an existing HIV protein which provides strong, lasting protection from the infection by stopping the virus replicating. This is not aimed as a cure for the virus. But the virus would stay latent, so it wouldn t develop into AIDS. With this treatment, the patient would maintain a healthy immune system.

Passive immunotherapy

Passive immunotherapy involves periodical administration of neutralizing HIV-specific antibodies (bNAbs) in the infected person to control the multiplication of the virus.According to a new study, this therapy to repress HIV infection can help control HIV without the need for antiretroviral drugs and hence eliminate the drawbacks associated with them.

MX2 gene

Scientists have discovered the new gene MX2 which can inhibit the HIV virus from spreading after it has entered the body. It opens up opportunities to develop either a molecule that mimics the role of MX2 or a drug which activates the gene s natural capabilities.

Genetically modified cells

The new gene therapy for HIV has been hailed a success after first clinical trial as its early positive signs have raised the hopes of a HIV cure. During the trial, it was observed that the patients defenses against HIV were raised after replacing some of their natural immune cells with genetically modified versions.

Melittin from bee venom

In an earlier study, researchers had demonstrated that a toxin called melittin found in bee venom might have the potency to kill the HIV. Scientists believe that this could be used to develop a vaginal gel to prevent HIV transmission or it could be used as an intravenous treatment to help those that have been already infected.

Immunotoxin (genetically designed HIV-specific poison)

A team of researchers has demonstrated in a mouse model that an HIV-specific poison can kill cells in which the virus is actively reproducing despite antiretroviral therapy. The scientists found that, compared to antiretrovirals alone, the addition of the immunotoxin significantly reduced both the number of HIV-infected cells producing the virus in multiple organs and the level of HIV in the blood. This might help achieve sustained disease remission, in which HIV can be controlled or eliminated without a lifetime of antiretroviral therapy.

Radioimmunotherapy (RIT)

Radioimmunotherapy (RIT) uses monoclonal antibodies cloned cells that are recruited by the immune system to identify and neutralize antigens. In RIT, the antibodies bind to the infected cells and kill them by radiation. Researchers have used RIT to destroy remaining HIV-infected cells in the blood samples of patients treated with antiretroviral therapy, offering the promise of a strategy for curing HIV infection. When HAART and RIT are used together, they kill the virus and the infected cells, respectively.

NeF protein

Researchers have identified a new protein Nef that holds promise for the next-generation of anti-HIV drugs. The protein hijacks host proteins and is essential to HIV s lethality.

New protein VRC07- CD3

HIV reservoirs have latent HIV-infected immune cells that can start making the virus when a person stops taking anti-HIV drugs. Scientists have created a new protein VRC07- CD3 that could help deplete HIV reservoir and contribute to a HIV cure. The protein awakens latent HIV-infected cells ( reservoirs ) and facilitates their destruction.

Tenascin-C (TNC) protein

Scientists have identified a protein, called Tenascin-C or TNC, in breast milk that may protect babies from acquiring the virus from their infected mothers. The protein in breast milk binds to and neutralizes the HIV virus, protecting exposed infants who might otherwise become infected from repeated exposures to the virus. The discovery could lead to potential new HIV-prevention strategies.

This article has been verified by Dr Mamatha M. Lala, Consultant - Pediatric HIV Telemedicine (UNICEF), Pediatric Center of Excellence - LTMMC & LTMGH, Sion, Mumbai. Medical Adviser & Consultant Pediatrician, Committed Communities Development Trust.

Image source: Shutterstock

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