Professor Sharon Lewin, Director, Doherty Institute, Melbourne, Australia, was recently a part of The Healthcare Transformation Talks at Arab Health, where she put the spotlight on the search for an HIV cure and why it’s needed. She summarised the science behind why a cure for HIV hasn’t been found yet and some of the strategies and testing that have been put in place to achieve a cure. Excerpts from the interview:
What strategies should be put in place to achieve a cure for HIV?
There are three main strategic areas. First is combination immunotherapy, which means enhancing the immune response through a range of methodologies. This is carried out by using neutralising antibodies, vaccines, or immunomodulating drugs. We are most interested in immune checkpoint blockers, as these are drugs that are used to enhance immune function. At the same time, the virus and the pool of infected cells need to be reduced. This can be done through what we call reversing HIV latency. Several different approaches are being used to do this, such as small molecules, mRNA, and lipid nanoparticles, among others.
The next approach is called ex vivo gene therapy or cellular therapy. This involves taking cells out of the body, modifying them to either become resistant to HIV or to enhance immune function to make CAR T-cells, which are then put back in the body.
The final approach is in vivo gene therapy, which means adding cells directly into a patient through gene editing tools that can either protect cells from HIV, enhance the immune response, or directly target the virus.
Is there any one approach that is showing more promise than the other?
In animal models, combination immunotherapy has been more advanced, meaning there have been more studies that have directly asked the question of enhancing immune function to achieve control of the virus in the absence of treatment, and some of those strategies have now moved into clinical trials. There is a very early indication from some of those trials that this may work for a small number of people. Gene therapy, on the other hand, has been tested in animal models, and there haven’t been any results in clinical trials indicating that this is going to work. I also think technological advances are very significant in gene therapy, particularly in vivo gene editing tools. So, I think all potential pathways have some promise. However, combination immunotherapy is more advanced.
What role is technology playing in helping find a cure?
We are using technology to understand why we don’t have a cure, in other words, where the virus is hiding on antiviral therapy. Technological advances are needed, for example, to analyse a single cell that carries the virus and then understand what’s different about it. Additionally, strategies rely heavily on technological advances in antibody development, vaccine production, etc.
What, in your opinion, will be the healthcare trends for 2023?
I think we are going see a lot of advances in gene therapy, ex vivo and in vivo, primarily because of the technological advances in those areas, which have been quite significant. They are very much driven by advances in mRNA therapeutics. At the same time, cancer immunotherapy is also advancing rapidly, which has direct implications for HIV.
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This article appears in the Daily Dose 2023. Read the full issue online today.