Interesting Times

The C-Word

The most effective ways to address HIV infections in late 2010 remain staying uninfected and if you are already infected getting on medications as soon as possible. The evidence for early intervention is now convincing but decades of being on the available potent chemotherapeutic agents certainly has its downsides.

What has proven to be very illusive over the past thirty years is of course the C-word, a cure. In the 1980’s it was felt by many activists involved in the epidemic that it was simply a matter of will, the willingness to devote adequate resources and a cure could be found. Many felt that all that kept this from happening was that it was infecting disenfranchised populations who lacked the political clout to mobilize enough resources make it happen. If only white straight men had been a significant at-risk-group.

Though the analysis that it was infecting the powerless still has some cache and credibility it also turned out that this little virus was very crafty in how it infected human beings. Western medical hubris aside this was a daunting infection that the science of the early years was simply not up to solving.

The reality of how our very sophisticated immune systems handled this particular virus was different and in ways less ‘effective' than how other viral infections were handled. The virus has the ability to hide away in a dormant fashion in reservoirs that the current medicines can’t crack. The current therapies do a great job of keeping the amount of circulating virus in the blood very low but if they are stopped the virus comes quickly out of hiding.

In the last few years however there has been resurgence in the effort to find a cure and certain of these efforts look quite promising though severely under funded. This is where a resurgence in AIDS activism is sorely needed at this time. This link is to an organization based in Philadelphia and San Francisco called the AIDS Policy Project.    All of us currently infected with HIV owe it to ourselves to become familiar with and hopefully participate in their efforts.

A recent case of a German man with HIV and leukemia who was treated with a bone marrow transplant for his leukemia resulted in a resolution of not only the leukemia but also seemed to clear his body of HIV. Now three years out this man remains free of HIV and is considered to have been cured. In research parlance this is referred to as “proof of concept”, in other words a cure is possible.

There are currently two cure approaches being looked at. The first is referred to as a functional cure and this involves the immune system being able to control HIV without drugs. The second approach is called a sterilizing cure that would be no HIV in the body any more at all. This is applicable to the Berlin man and I would again refer you to the above web site for some easy to understand detail around this case.

Certainly bone marrow transplants are expensive and no walk in the park from a patient perspective but the cost I saw quoted was $100,000. That is not chump change but the non-generic cost of HIV medicines in this country is often $15,000-20,000 per year. You do the math but it doesn’t take too many years to hit that amount.

Initially effective cures may be expensive but then so were (are) protease inhibitors. Outside the U.S. many AIDS medications are now available in generic form though and not prohibitively expensive. The very sad reality of course is that millions still do not have easy access to even these generic medications. Though daunting the initial monetary investment in finding a cure should not be prohibitive and may prove a more realistic avenue to all infected than the current lifelong treatments.

In a piece you can link to off the web site above the AIDS Policy Project hypothesizes a couple reasons why the pursuit of a cure has been so under funded and not getting the attention it deserves. The first is that hopes around a possible cure were raised repeatedly in the 1990’s but did not materialize, optimists got burned. The second is that the drug companies that might be in the forefront of cure research have found it more economically advantageous to concentrate on the proven moneymakers, current HIV medications.

AIDS activism has a long and very successful history. The activist agenda though has tended to be truncated in the past decade or so due to the effective, though in many ways problematic, medications available. It is time now to reactivate front line efforts around the fight for a cure. There are numerous ways to get involved that involve little more than access to a pen and paper. Please again visit the web site below (same as above) for ideas on how to get involved. There is also information at this site to flesh out many of the issues and prospects surrounding a cure for HIV infection.

http://www.aidspolicyproject.org/

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