Archive for November 26, 2013

The Times reports on the RIVER trial

Article in The Times on 26th November, reporting on the RIVER study:


“A potential cure for HIV will be tested on British patients next year in a ground-breaking trial of a treatment that aims to put sufferers into cancer-style remission.
The virus will be “woken up” from its hiding place within cells so that it can be targeted by a combination of drugs, in a first-stage study by a group of five leading universities supported by the Medical Research Council.
Although the 50 patients involved are unlikely to be cured, scientists hope that their reservoir of hidden HIV will be cut significantly, showing that the method has the potential to cure the condition in further studies. Even if the trial succeeds, it will be many years before any treatment is ready for routine use.
About 100,000 people in Britain have HIV and many live normal lives using antiretroviral drugs, which stop the virus from spreading within the body. A reservoir of the virus lies dormant within blood cells, however, and would re-emerge if patients stopped taking the drugs, potentially leading to Aids.
The UK trial will use a new chemotherapy drug to stimulate the virus so that it becomes visible to the immune system. The drug will be combined with a vaccine designed to kick-start the body into attacking HIV-infected cells.
“It feels counter-intuitive — why would you want to wake the sleeping virus in patients?” said John Frater of the University of Oxford, one of the trial leaders. “By using this drug, we can wake up HIV and that means the cells become targets. Previously they were camouflaged.”
Half the patients will receive HDAC (histone deacetylase) inhibitors, alongside the vaccine, while the rest will get a placebo. Both groups will also take standard antiretrovirals.
“We will test if we can reduce the number of HIV-infected cells in these patients. If we can, it will prove in principle that this strategy could work as a cure, even though it will need many more years of further development,” Dr Frater said.
Sarah Fidler, of Imperial College London, another project leader, said: “Research in the labs has led to some very promising results. We now have the opportunity to translate that into a possible new treatment.”
She added that the ultimate aim was “to look at HIV a bit like the cancer model, where you are in remission and can come off your drugs”.
Clinics in London and Brighton will ask for volunteers who have recently become infected, as treating the virus in the early stages offers the best chance of beating it. This means most recruits will be gay men who test regularly and know when they were infected.
“For many people this is a difficult and traumatic time so it’s challenging to say, ‘You’ve got this traumatic illness and we want you to start treatment and go on this trial’,” Dr Fidler said.
Two previous studies have used HDAC inhibitors to stimulate the reservoir, but the body did not kill infected cells, which is why the UK team is using the vaccine, developed at Oxford. Dr Frater said that if this vaccine did not work, a different combination might still be effective in future. .
Earlier this year, an HIV-positive baby was apparently cured in the US, while two men who had bone marrow transplants have stopped taking Aids drugs without the virus returning. They are the latest in a series of cases that have suggested HIV can be eliminated. The most famous was Timothy Ray Brown, whose HIV vanished after a bone marrow transplant for leukaemia.
Dr Frater said the apparent success of a variety of approaches had allowed normally cautious scientists to begin expressing hopes for a cure. “There’s genuinely a sense of optimism.”