4 ms·

Just to check I understand this correctly, as a layman: It stops HIV from progressing in the body, holding it at bay. Someone with HIV would need to take this

by Twirrim 10y ago

Just to check I understand this correctly, as a layman: It stops HIV from progressing in the body, holding it at bay. Someone with HIV would need to take this medicine for the rest of their lives. It doesn't actually cure it. (not denying that holding it at bay is a significant step forward)

carbocation 10y ago
(NB: I don't do HIV research.) You are correct. Obviously, curing HIV is an open research question, but also the way to go about curing this retroviral infection is still unknown. When there is sustained virologic response, we know that the virus will come back if drugs are withdrawn. Exactly which niche of cells have integrated HIV into their genome, and how to identify them, is an active area of research at least as of about a year ago when I last looked into it (hint: probably macrophages and T cells). The Berlin patient shows that cure is possible via treatments that also eradicate the bone marrow, but these are not generalizable across populations due to the high morbidity and mortality. For prevention, vaccination that can generate antibodies such as the one in the article would be highly valuable. Less valuable but still very beneficial would be a long-lasting monoclonal antibody injection that can be given once a month (or ideally less often) to reduce the likelihood that high-risk individuals become infected. For cure, I suspect that an approach which pairs replication suppression with genome editing tools, such as CRISPR, may ultimately prove successful in curing individuals of HIV.
- ekianjo 10y ago
  > The Berlin patient shows that cure is possible via treatments that also eradicate the bone marrow, but these are not generalizable across populations due to the high morbidity and mortality. Correct me if I'm wrong but I thought that patient got HIV back a year or two after the bone marrow transplant?
  - carbocation 10y ago
    We're actually both right: there are two patients referred to as "The Berlin patient." The first one is a man who was given an unusual ART regimen and has been able to stay off of it for an indefinite time, with low circulating levels of HIV. But this isn't the person that most physicians think of when we talk about the Berlin patient. Rather, we're thinking of the man who had a bone marrow transplant and has been truly cured.
space_fountain 10y ago
I think the ideal goal would be to create a vaccine that would induce a immune response producing this antibody immediately on contact with HIV. In that case I don't know that we know whether it would just keep it at bay or if it would be able to essentially prevent infection in the first place.
snowwrestler 10y ago
It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens. The question is whether all humans can produce this, or just some genotypes. If it's the latter, then yes, some people would have to take it as medicine and never stop.
- Twirrim 10y ago
  > It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens. Ahh, of course they do. Thanks for the clarification :) Either way this seems like an exciting result.
- ars 10y ago
  > then yes, some people would have to take it as medicine and never stop. Which is a problem since it would probably be a monoclonal antibody and those are the most expensive drugs to make. Like hundreds of thousands or even millions per year expensive (depending on what dose is needed). If it really does cost millions per year the US couldn't afford it - it would cost over a trillion per year to treat everyone in the US, and more than 40 trillion to treat everyone (and that's just for the medicine). (For comparison total healthcare spending in the US is 3 trillion.) So better hope that either the price goes down, or that it only requires a limited course of treatment. Can you imagine a cure for HIV, and we can't afford it?
  - nopinsight 10y ago
    What are the reasons behind such prohibitive cost? Rare expertise, advanced factories, amount of time required, lack of economy-of-scale, monopoly, something else? If the cure is proven, the society will likely be able to mobilize much more resources, particularly to scale up operations. Special expertise can be trained to other biologists (the underemployment problem would be mitigated as well). More biologists could be trained. Likewise for factories, materials, etc. Monopolies can be broken. What factors cannot be scaled up with such an approach? (Honest question. I do not know anything about antibody production.)

by Twirrim 10y ago

carbocation 10y ago

(NB: I don't do HIV research.) You are correct. Obviously, curing HIV is an open research question, but also the way to go about curing this retroviral infection is still unknown. When there is sustained virologic response, we know that the virus will come back if drugs are withdrawn. Exactly which niche of cells have integrated HIV into their genome, and how to identify them, is an active area of research at least as of about a year ago when I last looked into it (hint: probably macrophages and T cells). The Berlin patient shows that cure is possible via treatments that also eradicate the bone marrow, but these are not generalizable across populations due to the high morbidity and mortality. For prevention, vaccination that can generate antibodies such as the one in the article would be highly valuable. Less valuable but still very beneficial would be a long-lasting monoclonal antibody injection that can be given once a month (or ideally less often) to reduce the likelihood that high-risk individuals become infected. For cure, I suspect that an approach which pairs replication suppression with genome editing tools, such as CRISPR, may ultimately prove successful in curing individuals of HIV.

ekianjo 10y ago
> The Berlin patient shows that cure is possible via treatments that also eradicate the bone marrow, but these are not generalizable across populations due to the high morbidity and mortality. Correct me if I'm wrong but I thought that patient got HIV back a year or two after the bone marrow transplant?
- carbocation 10y ago
  We're actually both right: there are two patients referred to as "The Berlin patient." The first one is a man who was given an unusual ART regimen and has been able to stay off of it for an indefinite time, with low circulating levels of HIV. But this isn't the person that most physicians think of when we talk about the Berlin patient. Rather, we're thinking of the man who had a bone marrow transplant and has been truly cured.

space_fountain 10y ago

I think the ideal goal would be to create a vaccine that would induce a immune response producing this antibody immediately on contact with HIV. In that case I don't know that we know whether it would just keep it at bay or if it would be able to essentially prevent infection in the first place.

snowwrestler 10y ago

It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens. The question is whether all humans can produce this, or just some genotypes. If it's the latter, then yes, some people would have to take it as medicine and never stop.

Twirrim 10y ago
> It's an antibody, so in theory the human body can produce it itself. That's how vaccines work: they trick your body into producing antibodies against the real pathogens. Ahh, of course they do. Thanks for the clarification :) Either way this seems like an exciting result.
ars 10y ago
> then yes, some people would have to take it as medicine and never stop. Which is a problem since it would probably be a monoclonal antibody and those are the most expensive drugs to make. Like hundreds of thousands or even millions per year expensive (depending on what dose is needed). If it really does cost millions per year the US couldn't afford it - it would cost over a trillion per year to treat everyone in the US, and more than 40 trillion to treat everyone (and that's just for the medicine). (For comparison total healthcare spending in the US is 3 trillion.) So better hope that either the price goes down, or that it only requires a limited course of treatment. Can you imagine a cure for HIV, and we can't afford it?
- nopinsight 10y ago
  What are the reasons behind such prohibitive cost? Rare expertise, advanced factories, amount of time required, lack of economy-of-scale, monopoly, something else? If the cure is proven, the society will likely be able to mobilize much more resources, particularly to scale up operations. Special expertise can be trained to other biologists (the underemployment problem would be mitigated as well). More biologists could be trained. Likewise for factories, materials, etc. Monopolies can be broken. What factors cannot be scaled up with such an approach? (Honest question. I do not know anything about antibody production.)