Jan. 4, 2012
-- Toulon, France -- Although a number of promising approaches have led to testable hypotheses for an HIV cure, for which small animal and primate models may provide preliminary information, ultimately proof of concept and validation studies in human subjects will be required. These trials will need to balance the risks of significant toxicity, morbidity and mortality of novel strategies against the possible benefit to individual patients and knowledge gained overall. However, it is challenging to define an acceptable level of risk in the context of generally safe and effective life-long therapy. Would a small risk of fatal complication be acceptable? Would a modest risk of mortality, like 1-2% for coronary artery bypass grafting, be acceptable if a cure is on the horizon, or even more? The answers will probably depend of the therapies tested and their goal: functional (for how long) or sterilizing cure?
There are already innovative strategies ready to be tested in the clinic but most researchers think that only a combination of these therapies could lead to an HIV cure. Combining, or sequencing, these approaches also means increasing the risks. On the other side, do we have to test them one after the other, as we did with antiretroviral drugs, before moving to combinations?
These are difficult questions to answer, as it is evident that the first patients included in a single approach will get limited benefit from it, if any. This situation is particularly true for the first anti-latency agents tested. They will probably lack the potency to purge all HIV reservoirs, and it is not known if a remaining few infected cells would not be enough to reignite a whole infection.
All these questions were discussed in-depth at the last “International Workshop on HIV Persistence, Reservoirs and Eradication Strategies” held in December 2011. Participants coming from the lab, from the clinic, from agencies, and from pharmaceutical companies were all tied by their commitment toward an HIV cure. A detailed analysis of what they defined as their main priorities is currently underwriting and will be published soon.
Meanwhile, focused reports are available on the workshop website.
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