Last week, I retweeted a press release from the NIH about a presentation that Tony Fauci was going to make at the AIDS Conference, which featured the lead quote “Durable control of HIV infection in the absence of antiretroviral therapy is a feasible concept that deserves vigorous pursuit.” This was referring to the ‘cure’ strategy looking at whether people who have been durably suppressed on anti-HIV meds for awhile could, perhaps with the administration of other agents, develop an immune response that would keep the virus in check when they go off treatment (normally viral loads rebounds soon after stopping antiretrovirals).
But despite the press release, in Fauci’s presentation, which is available online, the human data from the most recently tested approaches were a bust. This included an open study evaluation whether the administration vedolizumab, an anti-inflammatory monoclonal antibody currently on the market for Crohn’s and ulcerative colitis, would increase the likelihood of durable HIV suppression in individuals. Although this was not a placebo controlled study, the results did not differ markedly from natural history (all but two of 18 vedolizumab-treated people rebounded soon after going off treatment). Now, it should be noted that there are some critical differences between vedolizumab and the similar antibody that worked in the primate model, so this HIV cure strategy may not be completely dead but as this piece by Jon Cohen in Science states, the results were still sobering.
Fauci does hold out some hope still for some other approaches, including one, the passive transfer of broadly neutralizing antibodies (bNABs), which looked promising in the SHIV primate model… particularly combinations of bNABS, but, again, the proof will be in the clinical pudding when the approach is tested in humans.
If I have a chance, I will try to sketch out a list of the cure/durable suppression data presented at the conference. That is, the data which is accessible online, since I wasn’t there in person.
One of those studies, the also disappointing RIVER study, has been written up by Gus Cairns on aidsmap.
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