Anthony Fauci

While new drugs and a better understanding of antiretroviral therapy has dramatically improved survival of people with HIV, existing treatments cannot "cure" the disease, or completely eradicate the virus.

But this may not be an impossible dream, National Institute of Allergy and Infectious Diseases Director Anthony Fauci suggested last week at the XVII International AIDS Conference in Mexico City.

Fauci indicated that it might one day be possible for HIV positive people who are treated early and aggressively with potent new drugs to eventually stop their medications and remain free of symptoms.

There is currently no known case of anyone with HIV being cured, Fauci said, because the virus has the unique ability to hide from the immune system in latent reservoirs that are established within days of infection. If antiretroviral therapy is interrupted, the hidden virus "springs back" and resumes its attack on immune system cells and other organs.

He suggested that diagnosing and treating people soon after they are infected -- and before the reservoirs become too large -- might prevent immune system damage and keep viral load low. Since the advent of HAART in the mid-1990s, experts have debated the benefits and risks of early versus delayed therapy. Today, recent evidence appears to be pushing the pendulum back towards earlier therapy, in part because new drugs are more potent and have fewer side effects.

Fauci further stated that it might be possible to "eradicate HIV microbiologically" in a few patients -- albeit "not very many." Even if the virus is not completely eradicated, however, intense early treatment might offer some patients a "functional cure" in the sense that they do not experience disease progression.

Despite recent setbacks in the field, Fauci also indicated that he thinks an effective HIV vaccine could be available within 20 years. HIV vaccine development has been challenging for a number of reasons, he said, including the fact that the virus mutates rapidly, hides from the immune system, and targets the very immune cells that fight most other pathogens. With HIV, he said, "we will have to do better than nature."

8/15/08

Sources

A Fauci. AIDS chief still hopeful for eventual vaccine, cure. CNN. August 5, 2008.

Kaiser Family Foundation. Fauci, Piot Discuss Progress in HIV/AIDS Treatments,
Prevention. HIV/AIDS Daily Summary. August 7, 2008.

S Pettypiece. AIDS May Be Curable, Preventable by 2031, Top Scientist Says. Bloomberg News. August 6, 2008.