Discussion of an endgame has been creeping back over the past few years
The question itself is blasphemy. Unlike other diseases, from Alzheimer’s to breast cancer, AIDS is not one we talk about curing. To talk about eradication is particularly careless and cruel, if only because the relatively brief history of AIDS is so riddled with hype and dashed hopes. In scientific circles, however, discussion of an endgame has been creeping back over the past few years, which is why Jon Cohen, writing for MIT’s Technology Review (July-Aug. 2010), argues that it’s time to put that “dirtiest of four-letter words”—cure—back on the table.
Researchers are in two camps, says Cohen, who is the author of Shots in the Dark: The Wayward Search for an AIDS Vaccine: There are those who are pursuing new “sterilizing” cures (total virus eradication), while others are probing the less ambitious but no less dazzling idea of a “functional” cure, which may leave a small amount of HIV in the body but allows people to stop taking antiretroviral drugs.
One functional cure innovator is Paula Cannon, a lead researcher on a team at the University of Southern California. Cannon has a special colony of mice that have been implanted after birth with human immune system stem cells, which then become a functioning immune system. Before the cells are implanted, the team introduces an enzyme that will cripple one of the two receptors HIV needs to attack in about 5 percent of mature cells. These immune system cells are resistant to HIV and, over time, as the virus kills off unaltered cells, it runs out of fodder for attack. “In some of the infected mice, the virus appears to have declined to such low levels that the animals need no further treatment,” Cohen writes.
Ultimately, the goal of both sterilizing and functional-cure research is the same: to eliminate the need for a lifetime course of drugs that are increasingly untenable because of the rising cost of antiretrovirals and the continued sluggishness of the world economy. Keeping a virus at bay for years also has side effects, including increased susceptibility to other diseases.
Research like Cannon’s, Cohen writes, poses “astonishing hope.”