French virologist Dr. Françoise Barré-Sinoussi, who shared the Nobel prize in medicine for her 1983 discovery of the retrovirus that causes AIDS, told a packed auditorium at Fred Hutchinson Cancer Research Center Tuesday that she is “personally convinced we can reach permanent remission—a functional cure” for HIV.
Delivering the keynote address on the first day of a two-day Conference on Cell and Gene Therapy for HIV Cure, Barré-Sinoussi made an impassioned case for why scientists should work toward a cure even though combination antiretroviral therapy has — for those who have access to and can tolerate the treatment — turned HIV from the death sentence it had been for the first 15 years of the epidemic to a largely manageable chronic disease today.
At the same time, Barré-Sinoussi stressed the scientific challenges that remain before a cure of any kind can be realized — whether the long-term remission that she and many others consider the most realistic goal or a so-called sterilizing cure that would eradicate all traces of the wily virus.
“Over the years, we realized, first for vaccine research and now for cure research, how much we need more basic science,” Barré-Sinoussi said.
So far only one person is known to have been cured of HIV, Timothy Ray Brown, who received a stem-cell transplant in Germany in 2007 to treat acute myeloid leukemia. His donor carried two copies of a rare gene mutation that confers resistance to HIV. Brown, who had been controlling his HIV with antiretroviral therapy before he developed cancer, has not taken HIV medicine since the stem cell transplant six years ago and his virus has not rebounded. Ordinarily, if a person stops taking the daily pill, the virus roars back within days or weeks.
Both expensive and risky, a stem cell transplant would not be appropriate for the vast majority of people with HIV unless they faced a similar life-threatening cancer. So researchers at the Hutch and elsewhere are investigating other approaches to cure, including using genetic engineering to create resistance in the cells of a person with HIV.
Among the challenges to cure research: Reservoirs of latent HIV-infected cells hide in the body, out of reach of antiretroviral drugs. Scientists have no tools to measure the reservoir or even find all its hiding places.
Hutch virologist and director emeritus Dr. Larry Corey opened the conference by welcoming about 100 scientists from around the country plus post-docs and graduate students to this “grand experiment.”
He also introduced Barré-Sinoussi, a long-time colleague and friend from the front lines of the battle against HIV.
“It’s impossible to overstate the worldwide impact Francoise has had,” Corey said. “What’s amazing about her is not only how clever and great she is but how nice she is, what an incredible ambassador of science she is. She’s known not only on her work on epidemiology and biology of HIV but also for her advocacy.”
In addition to her own research, Barré-Sinoussi promotes collaboration among HIV scientists and pushes for solutions that will work in resource-limited countries that are hard hit by HIV, especially sub-Saharan Africa.
In fact, it was from her frequent travels to South Africa and Asia that Barré-Sinoussi became interested in cure research. She regularly asks people with HIV, “What are you expecting of us as scientists?”
More and more, those she asked told her they wanted to be able to stop treatment. They wanted a cure.
“My lab was not really involved in cure,” she said, “but I thought maybe we should try to do more at the international level to reinvigorate interest.”
Barré-Sinoussi, who just finished a two-year term as president of the International AIDS Society, instituted a cure symposium as part of the group’s annual gathering. A survey presented at the first symposium reported that 72 percent of people with HIV said that it was very important to them to be cured.
The reasons? They would no longer have to be anxious about the future. They would no longer have to deal with the stigma. And they would no longer fear infecting others.
Thirty-five million people are living with HIV today, according to the World Health Organization.
But of those, only 13 million have access to live-saving therapies. And an estimated 19 million don’t know that they have HIV. About 2.1 million new people become infected each year.
Given these numbers, “Lifelong antiretroviral therapy is not likely to be sustainable,” Barré-Sinoussi said.
Barré-Sinoussi, 67, is director of the Regulation of Retroviral Infections Unit at the Institute Pasteur in Paris, where she has been involved in retrovirology research since the early 1970s. She has said she plans to retire from the institute next year, but will continue her work on HIV cure and advocacy.
The first Conference on Cell and Gene Therapy for HIV, which continues on Wednesday, is hosted by defeatHIV, a Hutch-led team that is investigating using genetically modified stem cells to cure HIV; the University of Washington Center for AIDS Research; and the UW Virology Division.
Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.