HIV Cure Research by Kate Krauss

A community perspectiveBy Kate Krauss, Executive Director

AIDS Policy Project

[email protected]

www.AIDSPolicyProject.org

Where are we in the search for a cure for AIDS?

What is a cure?

A cure is a permanent remission in absence of requirement for therapy.

A functional cure: Control of virus rather than elimination, without requirement for therapy.

--The Division of AIDS, US National Institutes of Health

www.AIDSPolicyProject.orgMarch 26, 2011Boston, Massachusetts

HIV Reservoirs

• Long-lasting groups of cells that are established shortly after HIV infection and can live for decades

• Cannot be killed unless they are activated.• They are actual locations (the brain, the gut)• They are populations of cells• There is no agreement yet as to how to

measure them--size, types of cells, functionality of cells

www.AIDSPolicyProject.org

NEJM Brief Report


4

Gero Huetter


5

Timothy Ray Brown


Two current strategies toward a cure

• Activate resting T cells (cells in the viral reservoirs), and use AIDS drugs to kill them.--Flush them out and kill them off.

• Repopulate the immune system with cells that have become resistant or immune to AIDS.


Possible curative therapies being investigated

1. HDACi - (Vorinostat)--a drug approved for skin cancer--clinical trials are starting in Melbourne, Australia and Chapel Hill, North Carolina

1. CCR5 gene therapy--Researchers are trying to duplicate the Berlin patient case.

2. Combination strategies to target latency - similar to cancer approaches. These combinations all look promising in vitro eg. HDACi+ methylation inhibitors or other combinations. There may be more than one mechanism of latency or a need for one drug to activate the virus and another drug to kill it.


Paula Cannon’s Mice

1. Collaborative effort between John Zaia at City of Hope in Duarte California and Paula Cannon at USC

2. California Center for Restorative Medicine (CIRM) ($15 million)

3. Give the mice human immune systems, infect them with HIV, take out their stem cells, cut out the CCR5 receptor, reinfuse them.

4. CURING MICE. People next?


Jay Lalezari’s People

1. University of Pennsylvania and Quest Research in San Francisco

2. Remove T-cells from long-term survivors

3. Snip out the CCR5 receptors using zinc finger technology (Sangamo, Richmond, CA near Oakland).

4. Reinfuse the cells, this time without their CCr5 receptors5. Therapy was safe; cells proliferated throughout the body and

migrated to the gut.

6. Increase of 100 CD4 cells

7. Almost didn’t happen because of patient enrollment problems


What percentage of its research budget did the National Institute of Allergy and Infectious Diseases spend on AIDS cure research?

In 2009, NIAID spent $40,652,172 on direct AIDS cure research. The total AIDS spending of NIAID in 2009 was $1.541 billion. Thus, NIAID spent less than 3% of it AIDS budget on direct cure research.

An additional $20 million was spent on AIDS cure research for the brain at another branch of the NIH.



Obstacles to a cure

1. Lack of funding--NIH spends 3% of its AIDS research budget on a cure.

2. Lack of good ideas--best and brightest aren’t all at the table. Young researchers, foreign researchers, novel ideas.

3. Research models that do not encourage collaboration --Myelin Repair Foundation

4. Red tape at the FDA/NIH/IRBs based on misunderstandings of what is ethical for people with AIDS. A 3 year wait--and counting--to test one promising therapy in people.


What can we do to hasten a cure for AIDS?

•More funding--$60 M is not enough•More funding streams-Opportunity for philanthropists to make a big difference in the course of the AIDS epidemic•Make opportunities for new ideas•New models of research (in addition to current)•Roadblocks in getting INDs, funding•Voices of PWAs at the table--clinical trial ethics, enrollment


AIDS Policy Project

• Diverse group of physicians, lawyers, advocates, community organizers launched a national advocacy campaign for a cure in November, 2009

• Found demoralized researchers--Larry Kramer and Jay Kostman, MD interview on our web site

• NIH was not tracking its spending on a cure.• Wrote first-plain English report on the cure.• Working with NIH and FDA to overcome obstacles and

bring more researchers to the table• Finding new ideas, new models• Turned outward toward the community: writing articles and

interviews, blogging, tweeting, etc about AIDS cure research.

• ORGANIZING• www.AIDSPolicyProject.org

AIDS Policy Project

• Grassroots conference on AIDS cure activism May 28, 29, and 30 in Philadelphia

• Meeting between FDA, NIH, and advocates next monthin Baltimore

• HIV provider conference in Palm Springs, CA on April 9


Gero Huetter,MD, physician who cured the first person with AIDS and researcher Steve Deeks, MD at a meeting organized by the AIDS Policy Project at the Zuni Café, San Francisco


AMSA and SGAC


Jose Demarco

Health & Medicine

HIV Cure Research by Kate Krauss