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The Cure

Doing the Work and Bearing the Burdens

Doing the Work and Bearing the Burdens

Doing the Work and Bearing the Burdens

A cure for HIV will take time and money, but it is worth it. 

The British astronomer royal, Dr. Richard van der Riet Woolley, famously told Time magazine in 1956 that the idea of space travel was absurd. “It’s utter bilge,” he said. Within five years the Russians were orbiting the earth and 13 years later Neil Armstrong and Buzz Aldrin were standing on the moon. 

Will we find a cure for HIV? There will always be those who say it can’t be done. That was brought home to me after a speech I gave in San Francisco in 2008. 

It was shortly after the case of “the Berlin Patient” was first reported in The Wall Street Journal. An HIV-positive man living in Berlin—an American named Timothy Brown—had developed leukemia and needed a stem cell transplant. In a shrewd move, his physician was able to find cells from a donor with a rare genetic mutation conferring resistance to HIV. After a lengthy, complex, and high-risk set of procedures, Mr. Brown was, and remains, HIV-free—and the first person ever to have been cured. 

The case was historic and, to my mind, a turning point in the field of HIV research. I conveyed my optimism about the possibility of developing a more broadly applicable cure to the San Francisco audience. The response was a flurry of angry calls and emails. Why was I giving false hope to people living with HIV? Did I not see that a cure was scientifically impossible? How could I be so irresponsible? 

Thankfully, there’s been a tectonic shift since then. Widespread skepticism has been replaced with genuine optimism about a cure among researchers. Yet the naysayers persist—even within the HIV and AIDS community. My organization—amfAR, The Foundation for AIDS Research—continues to be castigated in some quarters for being overly bullish. And the media seems to ping pong in its reporting on the subject, trumpeting the most recent research findings as evidence either that a cure is at hand or will never be possible after all. 

In all likelihood, there will be no eureka moment. It’s hard to prove a negative, and with our currently available technology, we still can’t say definitively that a person is absolutely free of every last remnant of HIV. We know from experience that the virus can rebound months or even years after we thought it was eradicated. 

And a cure could take a number of forms. It’s quite possible it will look more like the kind of long-term remission we’re used to seeing in cancer. The virus may still be there, but kept permanently at bay as a result of one intervention or another or a combination of therapies that create remission and are no longer needed to contain the virus. We believe we’ll have achieved a remission (sometimes called a functional cure) if a person is no longer infectious, doesn’t require lifelong treatment with antiretroviral therapy, and has no detectable virus for at least five years. 

What we need to do is to build the science around a cure. This will be incremental, evolutionary. We’ve identified the principal barrier—reservoirs, or pockets, of virus that remain in a person even after they have reached a so-called “undetectable” level of HIV as a result of antiretroviral therapy. It is now generally agreed that there are four key questions that need to be answered. Where exactly in the body are these reservoirs located? How do they become established and how do they maintain themselves? How much virus do they contain? And finally, how can we safely get rid of them? 

HIV research has largely evolved from a process of discovery to a challenge of technology. We need to develop the tools and agents to answer these key questions. Once we have answers, we can begin to cure some of the people some of the time, then most of the people most of the time. Ultimately, we hope, we’ll have a safe and effective cure that can be made available to all who need it. 

In his famous 1961 speech to Congress announcing his intention to put a man on the moon within a decade, President John F. Kennedy said there was no point agreeing to the proposition unless the country was prepared to “do the work and bear the burdens to make it successful.” 

At amfAR, we’re willing to do the work and bear those burdens and I’m confident that, with the right investments, we will find a cure for HIV. We recently launched a $100 million investment strategy with the aim of developing the scientific basis of a cure by the end of 2020. The centerpiece of the strategy is the amfAR Institute for HIV Cure Research, which we’re establishing in San Francisco with a $20 million grant over five years. Working in concert with other teams of researchers looking for answers to the questions outlined above, the Institute could become the nerve center for HIV cure research in the U.S. 

It may be that we won’t have the foundations of a cure by 2020. After all, 2020 is a goal, not a guarantee. But we’ll certainly be a lot closer than we are now and a lot better off for having tried. And if we ever have to choose between the naysayers and the optimists, amfAR will be on the side of the optimists every time. I guarantee it. 

Kevin Robert Frost is Chief Executive Officer at amfAR, The Foundation for AIDS Research.

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