question: How far are we from a cure for HIV/AIDS?
comment: We are pretty solid in terms of maintaining an infected person's immune system. But we currently do not have a mean of ridding a person completely of the virus. With the treatment options we have today, we can keep HIV in the body at such a low level that they would never develop into AIDS and would otherwise be a normal person. My fiance in nursing would often say HIV these days are better regulated than Diabetes. Viruses typically attack a host cell, and convert it into a factory to reproduce. The way our body defends against viruses would involve marking infected cells and attacking them with white blood cells. HIV (**H**uman **I**mmunodeficiency **V**irus) is problematic because the host cell it wants to attack is the white blood cell. When you are specifically targeting the one major defense system the body has, we have a very hard time dealing with it. AIDS (**A**cquired **I**mmuno**d**eficiency **S**yndrome) is the condition when enough white cells have been taken over that your body no longer has a functioning immune system. Typically, HIV is not the virus that would kill an individual, but when you no longer have an immune system, the next common cold that comes by will be deadly to the afflicted. edit for emphasis
passages: The failure of vaccine candidates to protect against HIV infection and progression to AIDS has led to a renewed focus on the biological mechanisms responsible for HIV latency. A limited period of therapy combining anti-retrovirals with drugs targeting the latent reservoir may one day allow for total eradication of HIV infection. Researchers have discovered an abzyme that can destroy the protein gp120 CD4 binding site. This protein is common to all HIV variants as it is the attachment point for B lymphocytes and subsequent compromising of the immune system.
  
  Section::::New developments.
   Other theoretical cures to HIV-1 have been proposed. One supposed cure to HIV-1 involves the creation of a disease-resistant immune system through transplantation of autologous, gene-modified (HIV-1-resistant) hematopoietic stem cells and progenitor cells (GM-HSPC). Though this study does involve several early stage clinical trials that have demonstrated the safety and feasibility of this technique only for HIV-1, none have resulted in improvement of the disease state itself. Therefore, this strategy is intended to go alongside already existing treatment techniques such as drugs and vaccines. However, future technology regarding this approach of single treatment cell therapy could potentially replace current therapy altogether as a functional or sterilizing cure to HIV-1.
   In 2003 a clinical trial in Thailand tested an HIV vaccine called RV 144. In 2009, the researchers reported that this vaccine showed some efficacy in protecting recipients from HIV infection (31% efficacy). Results of this trial give the first supporting evidence of any vaccine being effective in lowering the risk of contracting HIV. Other vaccine trials continue worldwide including a mosaic vaccine using an adenovirus 26 vector as well as a newer formulation of RV144.
   Section::::Stem cell based gene therapy.
  
  In the past 7 years, scientists have been using different approaches of stem cell based gene therapy in an attempt to develop a cure as well as to propose an alternative to the conventional antiretroviral therapy (ART). Specifically, advances had been made with a cure to HIV.
   Many trials have shown no efficacy but thus far, one HIV vaccine regimen, RV 144, has been shown to prevent HIV in some individuals in Thailand.
  
  Section::::Overview.
  
  The urgency of the search for a vaccine against HIV stems from the AIDS-related death toll of over 35 million people since 1981. In 2002, AIDS became the primary cause of death due to an infectious agent in Africa.
   One recent trial was conducted by scientists at The Scripps Research Institute (TSRI) who found a way to attach HIV-fighting antibodies to immune cells, creating a HIV-resistant cell population.
  
  Section::::Microbicides for sexually transmitted diseases.
   South African scientists in a combined effort with American scientists from Gilead Sciences recently tested and found effective a tenofivir-based anti-retroviral vaginal gel that could be used as pre-exposure prophylaxis. Testing of this gel was conducted at the University of KwaZulu-Natal in Durban, South Africa. The South African government has indicated its willingness to make it widely available. The FDA in the US is in the process of reviewing the drug for approval for US use. The AIDS/HIV epidemic has led to the rise in unethical medical experimentation in Africa.
   A turning point for HIV research occurred in 2007, following the bone marrow transplant of HIV sufferer Timothy Ray Brown. Brown underwent the procedure after he developed leukaemia and the donor of the bone marrow possessed a rare genetic mutation that caused Brown's cells to become resistant to HIV. Brown attained the title of the "Berlin Patient" in the HIV research field and is the first man to have been cured of the virus. As of April 2013, two primary approaches are being pursued in the search for a HIV cure: The first is gene therapy that aims to develop a HIV-resistant immune system for patients, and the second is being led by Danish scientists, who are conducting clinical trials to strip the HIV from human DNA and have it destroyed permanently by the immune system.
   BULLET::::- "“Treatment as prevention” strategies to blunt the rate of new HIV infections". Led by Gladstone scientists, the global iPrEx study showed how a daily pill could prevent HIV infection in people likely to be exposed; this study is currently in Phase-III clinical trials.
  
  BULLET::::- "HIV integration". Investigating the mechanisms by which HIV integrates and replicates within human hosts—while evading the host immune system.
  
  BULLET::::- "HIV Pathogenesis". Investigating the mechanisms by which HIV infects and kills lymphoid CD4 T-cells, the fundamental cause of AIDS, and the role of inflammation as a driver of HIV pathogenesis.
   BULLET::::- In July of 2019 the NIH announced that Ad26.Mos4.HIV would be entering Phase III trials. Ad26 is based on a live adenovirus, engineered to express several HIV proteins.
  
  "Therapeutic HIV vaccines"
  
  No therapeutic HIV vaccine candidates have reached phase 3 testing yet.
  
  Section::::Economics of vaccine development.
  
  A July 2012 report of the HIV Vaccines & Microbicides Resource Tracking Working Group estimates that $845 million was invested in HIV vaccine research in 2011.
   Alternative medical treatments to a vaccine exist. For the treatment of HIV-infected individuals, Highly Active Antiretroviral Therapy (HAART) medication has been demonstrated to provide many benefits to HIV-infected individuals, including improved health, increased lifespan, control of viremia, and prevention of transmission to babies and partners. HAART must be taken lifelong without interruption to be effective, and cannot cure HIV. Options for the prevention of HIV infection in HIV-uninfected individuals include safer sex (for example abstinence, partner reduction and condom use), antiretroviral strategies (pre-exposure prophylaxis and post-exposure prophylaxis) and medical male circumcision. Vaccination has proved a powerful public health tool in vanquishing other diseases, and an HIV vaccine is generally considered as the most likely, and perhaps the only way by which the HIV pandemic can be halted. However, remains a challenging target for a vaccine.
   Section::::Contemporary treatment issues.:Future steps to control HIV resistance.
   Section::::Clinical trials to date.:Phase III.
  
  "Preventative HIV vaccines"
  
  There have been no passive preventative HIV vaccines to reach Phase III yet, but some active preventative HIV vaccine candidates have entered Phase III.
  
  BULLET::::- In February 2003, VaxGen announced that their AIDSVAX B/E vaccine was a failure in North America as there was not a statistically significant reduction of HIV infection within the study population.
   In July 2010, a collaboration between the National Institute of Allergy and Infectious Diseases and officials at the Vaccine Research Center found that two human HIV antibodies, named VRC01 and VRC03, could potentially be used against a wide range of types and mutations of HIV in the design of a preventive HIV vaccine for human use, as well as in the formation of better antiretroviral therapy drug cocktails. The discovery, a potentially landmark one in the drive to find a vaccine for AIDS should it be validated and further improved, will be featured in the journal Science.
   Even with all latent virus deactivated, it is thought that a vigorous immune response will need to be induced to clear all the remaining infected cells. Current strategies include using cytokines to restore CD4+ cell counts as well as therapeutic vaccines to prime immune responses. One such candidate vaccine is Tat Oyi, developed by Biosantech. This vaccine is based on the HIV protein tat. A brief report of their phase I/II clinical trial reported it was safe and well tolerated in 48 HIV-positive patients. Animal models have shown the generation of neutralizing antibodies and lower levels of HIV viremia.
   Dr. Sadhna Joshi at the University of Toronto is working to discover
  
  ways to combat HIV through gene therapy. In her research, Dr.
  
  Joshi targets both the cells that are infected by HIV, and the virus
  
  itself. Dr. Joshi is experimenting with ways to prevent infection by
  
  removing receptors that HIV uses to enter immune cells. She is also
  
  targeting genes in HIV to prevent replication after infection.
  
  Dr. Clifford Lingwood from The Hospital for Sick Children and
  
  Dr. Donald Branch from Canadian Blood Services have identified
  
  a new resistance factor in the battle against HIV. They discovered
   Two closely related types of HIV have been identified, HIV-1 and HIV-2. While HIV-2 is spreading in India and West Africa, HIV-1 is more virulent and the number one cause of AIDS worldwide. Though some of the patients have different results in most cases people infected with HIV go on to develop AIDS and ultimately die of opportunistic infections or cancer.
   Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/µL is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). TASP is associated with a 10 to 20 fold reduction in transmission risk. Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in people at high risk including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. It may also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years. The USPSTF, ini a 2018 draft, recommended PrEP in those who are at high risk.
   Through innovative studies of the treatment of HIV-1 infection and its complications, ACTG research focuses on:
  
  BULLET::::- New therapies based on knowledge of the cellular events and reactions in the development of disease (pathogenesis)
  
  BULLET::::- Treatment strategies to limit replication of HIV-1 and improve disease-free survival among infected individuals
  
  BULLET::::- Rapid development of agents (drugs or treatment strategies) that prevent or delay the complications of HIV-related disorders
  
  BULLET::::- HIV-1 pathogenesis through advanced laboratory investigation
  
  BULLET::::- Recruitment and retention of clinical trial participants who reflect the changing demographics of the AIDS epidemic
   Bruce Walker commented on the outcome of Study 806. Walker was the director of the Harvard Medical School division of AIDS at Massachusetts General Hospital, the largest teaching hospital for Harvard Medical School. He wrote, “"The study was stopped prematurely due to the decrease in AIDS-related illness resulting from the introduction of more effective antiviral drug combinations. In addition, the study was not well controlled. Participants differed in terms of the antiviral medications during the course of that study, making interpretation of the findings problematic." Nonetheless, Walker found in the study “the first clear demonstration of the potential reconstitution of the immune response in chronic HIV infection…This is the first proof of the principle that therapeutic vaccination can help people with chronic HIV infection mount a strong CD4 helper cell response.”
   Acquired immunodeficiency syndrome (AIDS) is a leading cause of death in the world. It was identified as a disease in 1981. Two years later the etiology agent for AIDS, the HIV was described. HIV is a retrovirus and has two major serotypes, HIV-1 and HIV-2. The pandemic mostly involves HIV-1 while HIV-2 has lower morbidity rate and is mainly restricted to western Africa.
  
  In the year 2009 over 40 million people were infected worldwide with HIV and the number keeps on growing. The vast majority of infected individuals live in the developing countries.
   The main obstacle to conventional antiretroviral therapy eliminating HIV infection is that HIV is able to integrate itself into the DNA of host cells and rest in a latent state, while antiretrovirals only attack actively replicating HIV. The cells in which HIV lies dormant are called the viral reservoir, and one of the main sources is thought to be central memory and transitional memory CD4+ T cells. Recent reports of the cure of HIV in two infants are presumably due to the fact that treatment was initiated within hours of infection, preventing HIV from establishing a deep reservoir. Currently there is work being done to try to activate reservoir cells into replication so that the virus is forced out of latency and can be attacked by antiretrovirals and the host immune system. Targets include histone deacetylase (HDAC) which represses transcription and if inhibited can lead to increased cell activation. The HDAC inhibitors valproic acid and vorinostat have been used in human trials with only preliminary results so far.
   BULLET::::- Saquinavir, a new type of protease inhibitor drug, becomes available to treat HIV. Highly active antiretroviral therapy (HAART) becomes possible. Within two years, death rates due to AIDS will have plummeted in the developed world.
  
  BULLET::::- March 26, Rapper Eazy-E dies from AIDS-related pneumonia.
  
  BULLET::::- April 4, British DJ and entertainer Kenny Everett dies from AIDS.
   There is currently no cure or effective HIV vaccine. Treatment consists of highly active antiretroviral therapy (HAART) which slows progression of the disease. more than 6.6 million people were taking them in low and middle income countries. Treatment also includes preventive and active treatment of opportunistic infections.
  
  Section::::Treatment.:Antiviral therapy.
   Section::::Immunomodulatory agents.
  
  Complementing efforts to control viral replication, immunotherapies that may assist in the recovery of the immune system have been explored in past and ongoing trials, including IL-2 and IL-7.
  