The drug that can kill AIDS

Knapps

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10, Nov 2016

The Human Immunodeficiency Virus (HIV) has claimed 25 million lives and continues to affect millions more. Israeli scientists have identified a new protein, Gammora, that they claim reduces the virus in infected patients by 97% in just 8 days. Unlike other antiretroviral drugs that act by suppressing the virus, this peptide triggers self-destruction of the infected cells. Knappily looks into this promising development and analyses why there is no cure for AIDS.

What is the claim?

  • Professors Abraham Loyter and Assaf Friedler from the Hebrew University have identified a protein called Gammora that they say can reduce HIV in infected persons by 97%. What is the process by which Gammora acts
  • When a person is exposed to HIV, the virus immediately attacks the immune system, by destroying certain infection- fighting cells, known as CD4 cells. HIV incorporates one or two copies of its DNA into CD4 cells. This allows the virus to effectively take over that cell, using it as a factory, producing more of itself.
  • Gammora essentially forces multiple copies of the HIV DNA to enter the cell, causing the cell to go into overdrive, resulting in the cell committing suicide.
  • Unlike the current medications which suppress the HIV, Gammora causes self-destruction of all the cells containing HIV. Thus, it can get rid of the virus in the infected humans completely and forever.

Note: CD4 cells are a type of white blood cells that play a major role in protecting the human body from infection. The higher the CD4 count, the better are the chances to fight HIV or any other infection. A very low CD4 count - less than 200 cells/mm3 - is one of the ways to determine whether a person living with HIV has progressed to AIDS.

Why has AIDS cure eluded science for long?

This is because of the unique ability of the virus to become latent, i.e., virus latency.

  • During the first few weeks when a person is infected with HIV, many copies of this virus go into hiding in many different cells in the body. This is called the ninfection reservoirn. The problem is when the HIV is in hiding, the medicines cannot get to it to kill it. So, even though the medicines we have can eradicate HIV floating in the blood, more HIV viruses then come out of their hiding place to keep the infection going.

Virus latency is a challenge both for effective anti-HIV immunity and for accurate assessments of disease status.

When did the AIDS epidemic begin?

  • Gaëtan Dugas, a Canadian, was a relatively early HIV patient who once was widely regarded as "patient zero".
  • Dugas is featured prominently in Randy Shilts's book And the Band Played On (1987), which documents the outbreak of the AIDS pandemic in the United States. Shilts, who too was a gay HIV patient and died of AIDS in 1994, portrayed Dugas as having almost sociopathic behavior by allegedly intentionally infecting, or at least recklessly endangering, others with the virus. Dugas is described as being a charming, handsome, sexual athlete who, according to his own estimation, averaged hundreds of gay sex partners per year. He claimed to have had over 2,500 sexual partners across North America since becoming sexually active in 1972.
  • His case was found to have been only one of the many that began in the 1970s, according to a September 2016 study published in Nature. The study used computer models to trace genomes of affected HIV patients.

Where is the search for the final cure heading to?

The development of highly effective antiretroviral drugs represented a major turning point by allowing people living with HIV to live long and healthy lives.

  • 1980s: Once the term AIDS was defined by the US Centre for Disease Control (CDC) the focus was initially on preventing the transmission of the disease. Later in 1987, the American drug regulator FDA approved the first antiretroviral drug, zidovudine (AZT), for the treatment of HIV. AZT was not the miracle drug many hoped for. Early prescriptions often elicited toxic side-effects and only offered a temporary benefit, as the virus quickly mutated to become resistant to the treatment.
  • 1990s: In mid 1990s, the FDA approved the first protease inhibitor beginning the era of Highly Active Antiretroviral Treatment (HAART). Researchers then expected that this drug cocktail would help avoid the problem of drug resistance. But when the time came for the first patients to stop their drugs, the virus again seemed to outwit modern medicine.
  • 2000s: Efforts were made to reduce the price of anti-retroviral drugs and a global fund under the aegis of the United Nations was created to support efforts by countries and organisations to combat the spread of HIV.
  • 2010s: In the three decades since, over 25 more highly-potent drugs have been developed and FDA-approved to treat HIV. When two to five of them are combined into a drug cocktail, the mixture can shut down the virus’s replication, prevent the onset of AIDS, and return life expectancy to a normal level. However, patients must continue taking these treatments for their entire lives.

Current research

  • Nano-medicine: Researchers are aiming to improve the administration and availability of drug therapies to HIV patients through the use of nanotechnology.
  • Monoclonal antibodies: Recently a research made a breakthrough by treating rhesus macaques with a combination of antiretroviral drugs combined with antibodies which would help boost the immune system after infection. The recent discovery of the peptide that is named Gammora raises hopes for the final cure of this debilitating fatal disease.

Who will benefit from the cure?

HIV/AIDS is the deadliest epidemic of our time. Over 25 million people have already lost their lives, and more than 38 million are currently living with HIV/AIDS.

A recent study by the journal Lancet reported the following findings

  • Global HIV incidence reached its peak in 1997, at 3·3 million new infections.
  • Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005.
  • The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million in 2015.
  • At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths in 2005, to 1·2 million deaths in 2015. There has been substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had increases in rates of change in annual new infections.
  • In Africa’s hardest-hit countries such as Botswana, Swaziland and Zimbabwe, the AIDS epidemic has spread rapidly.
  • In other countries, the disease is still in its early stages. Notably, HIV/AIDS has now taken hold in the largest countries of the world: the number of people infected with HIV has reached one million in China and six million in India.

More than a health issue

The epidemic affects every aspect of human life, with devastating consequences for every sector of society. The UN report on Impact of AIDS reveals wide ranging societal impacts of HIV/AIDS.

  • On Family: The family of an HIV-infected person runs the risk of losing an adult in the prime of life, leaving behind not only a bereft family, but in most cases also an HIV-infected spouse and orphaned children.
  • On Agricultural sustainability: The Food and Agriculture Organization of the United Nations estimated that the ten most severely affected African countries will lose between 10 and 26 per cent of their agricultural labour force by 2020 due to HIV.
  • On Business enterprise: It affects enterprises of all sectors as the most productive workers in the labor force become too ill to work and eventually die.
  • On national economic growth: Countries with high HIV prevalence have lower outputs in all sectors. Funds for investment and savings are often diverted to pay for health care and social welfare benefits for afflicted families. As a result, economic development likely stalls or loses ground.

How can AIDS be tackled till a cure is found?

UNAIDS recommends a scale-up of antiretroviral therapy and adopting a fast-track approach: substantially increasing and frontloading investment over the next five years to accelerate scale-up and establish the momentum required to overcome within 15 years one of the greatest public health challenges in this generation.

Approach

  • Prevention: An array of effective HIV prevention tools include condoms, harm reduction, voluntary medical male circumcision, pre-exposure prophylaxis, cash transfers for girls and structural approaches that promote gender equality and access to secondary education. Community- and peer-based approaches to sharing prevention tools are effective.
  • Treatment: Highly Active Antiretroviral therapy (HAART) is the combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body.

Most commonly used combinations under HAART are:

  • Efavirenz tenofovir emtricitabine
  • Ritonavir-boosted atazanavir tenofovir emtricitabine
  • Ritonavir-boosted darunavir tenofovir emtricitabine
  • Raltegravir tenofovir emtricitabine

A combination of preventative as well as improved compliance to treatment regime could help in decreasing morbidity and mortality associated with HIV and improving the quality of life in those affected with HIV.

Note: In a progressive move, Indian government earlier this month approved amendments to make the HIV/AIDS (Prevention and Control) Bill, 2014, which makes it obligatory for the central and state governments to provide for antiretroviral therapy (ART) and management of opportunistic infections (infections that take advantage of weakness in the immune system and occur frequently). It prohibits specific acts of discrimination by the state, or any other person, against HIV-positive people, or those living with such people.

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Tags | AIDS antiretroviral drugs Gammora