Feature HIV/AIDS

The slow and unknown route to a cure for AIDS

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5265 (Published 10 August 2012) Cite this as: BMJ 2012;345:e5265
  1. Bob Roehr, freelance journalist
  1. 1Washington, DC
  1. BobRoehr{at}aol.com

Progress on several ways that a cure for AIDS might be developed was a source of optimism at the recent international AIDS conference, reports Bob Roehr

A growing acceptance that the “Berlin patient,” Timothy Ray Brown, is the first person to have purged the virus from his body has sparked a renewed interest in a cure for HIV infection.1 Brown has also announced the formation of a charity to promote the search for a cure.

This, and other tantalising evidence that a cure for HIV infection might be possible, inspired optimism among almost 24 000 delegates at the recent 19th international AIDS conference in Washington, DC. But the route to a cure is unclear and likely to take decades.

Conference participants revelled in the expansion of treatment to eight million people in the developing world, which was unimaginable less than a decade ago, when only tens of thousands were being treated. They took hope from new prevention tools, such as a rollout of voluntary circumcision, approval of the first drug treatment for pre-exposure prophylaxis2—tenofovir/emtricitabine (Truvada)—and solid evidence that treatment contributes to prevention by lowering HIV viral load. When combined with other prevention tools, it seems that the number of new infections might be held in check until a vaccine can be developed.

Brown’s regimen was an arduous one designed to treat his leukaemia. It involved chemotherapy, radiation, and bone marrow transplantation, with a one in a million match that contained a rare naturally occurring genetic mutation (ccr5Δ32) that confers resistance to HIV.1 When he stopped the treatment the virus did not reappear.

The regimen is not easily replicated, but it did generate the first tangible proof that a cure is possible. And it opened the door to explore other approaches that fall into two broad categories: eradication …

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