The HIV Challenge: A shift to early diagnosis and treatment as we wait for a cure

by Ariola Bardhi

Online dating has become very popular in recent years as websites such as match.com and eharmony.com have been attracting many users and advertising successful matches that have led to marriages. Following this trend, other websites that narrow down the search for the ideal partner have been created. The best examples are dating websites based on religion such as JDate and Christian Mingle. Among these user-selective websites one can also find dating sites for HIV positive individuals. HIVpassions and similar sites aim to connect people infected with HIV and provide a source for new friendships and dating. Even though the basic idea remains the same—people looking for other people that share a common characteristic or interest—one can appreciate the fact that the online dating sites for HIV infected individuals function as much more than a simple “get to know new people” kind of sites. They can provide the support that many HIV patients often lack from their families and useful information coming from people who have more experience with managing the disease. Most importantly, users can sign up anonymously, so these sites can actually target groups that decide to keep HIV a private health matter and have access to limited supported. Considering the advantages, it looks like social media will become very important in the HIV/AIDS prevention programs in the technology area where everyone one stays connected.

It has been more than 30 years since HIV was first isolated and discovered, and yet, there is no cure for it. The current treatment consists of a combination of three different antiretroviral drugs (combined antiretroviral therapy, or cART) from at least two different classes of HIV drugs to keep the virus under control and prevent mutations that would lead to resistance against one drug. In 2009 a clinical trial for a vaccine candidate, known as the RV144 clinical trial, was performed in Thailand. This trial gave the first indications that there is still hope for the development of an HIV vaccine, even though it resulted in an efficacy of only 31%. The results and implications from this study are still being examined and the mechanisms of protection elicited by the vaccine are under further investigation. Progress is also being made in developing new classes of drugs such as CD4 attachment inhibitors, maturation inhibitors, lens epithelium derived growth factor inhibitors and capsid assembly inhibitors, which target new specific ways of suppressing the replication of the HIV virus. However, as intense research continues in these areas, it seems like our best alternative against HIV is to prevent the virus from spreading, and help those who are infected to get diagnosed early and get treated immediately.

Currently, big efforts are being made in educating the world population on HIV/AIDS. UNAIDS and UNFPA run comprehensive programs in developing countries with a high prevalence of HIV infections in educating the youth and groups at high risk of exposure who come from disadvantaged backgrounds. Additionally, circumcision as prevention has been encouraged since 2007 in Sub-Saharan Africa, since this procedure is known to reduce the chance of acquiring HIV through heterosexual intercourse by 60%. The recent development of a non-surgical circumcision tool approved by FDA, PrePex, might represent a significant advance in this effort. PrePex consists of two plastic rings, a rubber band, and a thread; It is very easy and quick to use, and it requires neither a sterile surgical room, nor anesthesia. The product is currently pending WHO approval, and, if it does receive it, the target of circumcising 20 million men in Sub-Saharan Africa by 2015 set by WHO and UNSAIDS might not be impossible.

In the developed world, on the other hand, HIV/STI educational programs have been around for many years. As a result now the attention is moving towards using social media to increase knowledge of HIV/AIDS, and understanding the social circumstances that characterize individuals at high-risk of infection. For instance, this year investigators at UCLA completed a study where they recruited African American and Latino men who have sex with men, and got them to participate in health-related Facebook groups to discuss topics on HIV prevention, stigma, and testing. They were successful in reaching out to many other individuals from the same target group and increasing their knowledge on HIV. Other researchers at John Hopkins Bloomberg School of Public Health have been looking at the relationship between the social network and HIV sexual risk behavior among urban African American women. Their study included 513 African American women and showed a strong correlation between high-risk sexual behavior and unemployment, depression symptoms, drug use, as well as large social networks with more network members who help financially. The results of this study can be used to develop specific HIV prevention programs to target impoverished women. An example is the microenterprise program that teaches the cohort of high-risk women a skill that enables them to gain money. A source of income, on the other hand, reduces the chances for sex-trade partners and HIV acquisition.

During this year there has been an especially increased focus in early HIV diagnosis as the success stories of ‘functional cures’ took over the news. A ‘functional cure’ for HIV means the ability of the patient to sustain the viral load at very low levels without treatment. This has been reported twice in 2013. The first case was documented by the ANRS VISCONTI study where 14 patients were found to control viremia after a prolonged interruption of treatment with a combination of antiretroviral drugs. The second case was that of a baby girl in Mississippi, who contracted the virus in the womb from her mother, and began treatment with antiretrovirals 30 hours after birth. 18 months later her treatment was interrupted for 5 months, and testing after that time period confirmed the remission of the virus. The key message from both stories is that early treatment can lead to successful control of the virus. All of the 14 patients studied by the French group had started treatment within 10 weeks after infection, and the baby received antiretroviral therapy less than 2 days after birth.

If treatment is still far from a cure, and educational measures to increase awareness on protection and testing have been implemented, the question that rises is: can the diagnostics be improved? Improvement in HIV testing can be made in at least two main directions.

Firstly, HIV testing needs to be more widely accessible. Ways to test people in rural impoverished areas in Africa are desperately needed. Fortunately, Dr. Samuel Sia, an associate professor in bioengineering at Columbia, has been thinking about this problem. He has used his lab-on-chip technology to develop a low-cost device that can test for HIV in only 15 min, and can synchronize the data with patient health records from across the globe. The device, called the mChip uses fluid miniaturization techniques to perform ELISA (one of the standard ways to test for HIV antibodies) functions. It only needs a little blood and it presents the results in color-coded manner, so it very easy to read. In addition, it is great for diagnostic purposes in remote areas where people don’t have access to a health care center.

Secondly, testing can be improved by finding new sensitive ways that can detect the virus very early after infection. Right now most of the traditional tests detect the levels of HIV specific antibodies produced in the body in case of infection. However, in order to treat the patient early, the virus needs to be detected before the antibodies are produced (which takes several weeks). In fact, one of last year’s Grand Challenges Explorations Grants winners focused on this aspect of diagnostics. Dr. Shengxi Chen of Arizona State University proposed to develop a fluorescent protein sensor to detect HIV at low cost. He plans to develop a fluorescent sCD4 protein that changes color when it binds to the HIV envelope protein gp 120. This method would detect the virus immediately after infection and it would really be a significant step forward in early diagnosis. Even though it is still early to know about the progress of this project, the big push in the HIV field toward prevention and diagnostics will certainly bring a new development in this aspect in the next few years. These new approaches on the HIV challenge will at least help to lower the cases of new infections and control the virus better, as extensive effort is made to generate a cure and a vaccine against HIV.

Ariola Bardhi is a second year PhD student in the laboratory of Dr. Harris Goldstein in the Microbiology & Immunology Department. She comes from Tirana, Albania, and it was her love for science and medicine that made her move to the U.S. where Ariola thinks she has more opportunities to make a contribution in science. Ariola enjoys reading, writing, watching historical movies, and learning new languages. She also loves the art life that NYC offers.

 

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