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Cure: Little Progress & Disappointing thus far, Researchers say
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"Much has been learned, but little therapeutic progress has been made......Efforts to reverse HIV-1 proviral DNA integration in the host cell genome and those to enhance anti-HIV immunity have been disappointing thus far.....if a cure of HIV-1 infection is achieved, questions will remain as to the residual immune damage left in its wake and its reversibility60,61."
Aging IS THE DEFINING PROBLEM IN HIV OF OUR TIME
Aging & HIV remains a real problem causing suffering in older aging HIV+ deteriorating with ongoing persistent frailty, cognitive/mental & physical decline. There are 1.2 million HIV+ in the USA with 50% over 50 = 600,000, and 20% over 60 (63% over 50 in SF, 55% in NYC) = 250,000 over 60. If 25% of those over 60 are disabled or severely impaired mentally & physically that is 60,000. I estimate 6,000 over 60 in NYC alone are physically & mentally disabled: depression, frailty, brittle bones, heart disease, cognitive impairment. Death rates will increase due to multi-comorbidty & frailty, and quality of life for these people is bad and will likely get worse. Its estimated that in 12 years 75% in the USA with HIV will e over 50, that 80% will have heart disease, 30% cancers and 23% diabetes. The HIV Wash DC Cohort reported recently that 50% of the HIV+ people in their court in Wash DC were not evaluated or treated for comorbidities. The promise of ART is gone, disappeared for many discouraged older HIV+ who have fallen to the ravages of frailty & multicomorbidity. They feel abandoned & hopeless. They need support services, better care in the clinic, and better research. Many of them do not even know they are not getting adequate & comprehensive care, many of them don't even know they are suffering HIV caused premature or accelerated aging, they don't understand. Jules Levin, NATAP
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Toward the Cure of HIV-1 Infection:
Lessons Learned and Yet to be Learned
as New Strategies are Developed
Jeffrey M. Jacobson1,2 and Kamel Khalili1
1Department of Neuroscience, Center for Translational AIDS Research; 2Department of Medicine. Lewis Katz School of Medicine, Temple University,
Philadelphia, USA
Abstract
Here, we review the progress that has been made in achieving a cure of HIV-1 infection. To date, this has
only occurred in one person after he received allogeneic stem cell transplants from a CCR5 Δ32 homozygous
donor in addition to chemotherapy and radiation to treat his acute myelocytic leukemia. The general
consensus is that achieving a sustained remission of infection in the absence of antiretroviral therapy will
involve a combination of strategies that involve both the targeting of the latent proviral genome and the
induction of more effective anti-HIV-1 immune responses. Efforts to reverse HIV-1 proviral DNA integration
in the host cell genome and those to enhance anti-HIV immunity have been disappointing thus far. The
lack of clinically validated assays to measure both effects has hampered the development of effective
therapies. We suggest the consideration of genome editing as a new approach to reduce the latently integrated proviral genome. In addition, new approaches to therapeutic immunization, alterations of immunoregulatory
pathways, anti-HIV-1 antibodies, and anti-HIV-1 chimeric antigen receptor T lymphocytes are in
development. (AIDS Rev. 2018;20:220-225)
Corresponding author: Jeffrey M. Jacobson, jeffrey.jacobson@temple.edu
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