The Countdown to a
Cure for AIDS
amfAR’s “Countdown to a Cure for AIDS” is a research initiative aimed at finding a broadly applicable cure for HIV by 2020. “Countdown to a Cure” is designed to intensify amfAR’s cure-focused HIV research program with plans to strategically invest $100 million in cure research over the next six years.
About Countdown to a Cure
There has never been a more optimistic time in the world of AIDS research. New breakthroughs over the last several years have brought the scientific community a new understanding of the challenges that must be overcome to get to a cure. And there is growing confidence that, with the right investments, these challenges can be overcome.
The case of the Berlin Patient, first reported in 2008, was a watershed moment in the field of HIV research and a proof of principle that a cure was possible. In 2013, amfAR-funded researchers documented the case of the first child to be cured of HIV, and in France, a group of patients were reported to be in sustained remission.
These and other advances have created a groundswell of optimism about the prospects for a cure. This momentum, coupled with the availability of new and emerging technologies, has led us to believe that now is the time to mount an all-out effort to find a cure and finally bring the global AIDS epidemic to an end.
The Challenges of Curing HIV
amfAR has established a “research roadmap” that identifies the four key scientific challenges that represent the principal roadblocks to a cure:
Chart the precise locations of viral reservoirs that persist in the body;
Understand how HIV persists in the reservoirs;
Record how much virus they hold; and
Eliminate the virus
Achieving the Goal
To reach the ambitious goal of a cure by 2020, amfAR is changing the way it funds research by moving away from a passive investment strategy to one that will be more aggressive and focused on collaborative approaches to addressing the unanswered questions. To help direct the research and to ensure that investments are made in the most promising areas, amfAR will establish a “Cure Council,” a volunteer group comprising some of the world’s leading HIV/AIDS researchers.
Countdown to a Cure FAQs
Why does amfAR believe a cure is possible by 2020?
The scientific obstacles to a cure have, for the first time in history, been clearly illuminated. With a directed, collaborative and aggressive research effort, we believe that these challenges can be overcome if we make the right investments now.
What has changed since the start of the epidemic, 30+ years ago, to make the idea of a cure more plausible?
Perhaps the most important development has been the case of the Berlin Patient, the first person to be cured of HIV, which was first reported in 2008. The case provided a proof of principle that a cure was possible. Up until that point, AIDS research was largely a process of discovery. Now, knowing the key scientific questions that need to be answered, we're moving into a new phase of problem-solving research that is more of a technological challenge.
How does amfAR define cure in relation to HIV/AIDS?
To be considered cured, an infected person would need to meet three criteria: 1) be able to live a normal, healthy lifespan; 2) be off antiretroviral therapy or any other HIV-related medications; and 3) be incapable of transmitting the virus to others.
What are the scientific roadblocks to finding a cure?
There are four scientific roadblocks to finding a cure. First, we need to Chart the locations of the reservoirs of virus that persist even when a person is taking antiretroviral therapy. Second, we need to Understand how these persistent reservoirs are established and maintained. We also need to Record the amount of virus contained within the reservoirs. And finally, we have to Eliminate the reservoirs and other adverse consequences of HIV infection (e.g., immune dysfunction). If we do these four things, we’ll have a CURE.
Will one cure work for all HIV strains or will multiple “cures” be needed?
Research will tell us the answer to this. There are several factors that may influence the effectiveness of a cure, including how long the person has been infected; the route of infection; the person’s age when he or she acquired HIV, as well as current age; how soon they started antiretroviral therapy; and whether they have opportunistic infections or other HIV-related health problems. Depending on the nature of the cure, the HIV strain may also influence the type of cure needed. We might start by curing some of the people some of the time. It might be that there won’t be a single cure for all, but at this stage we can’t say for certain.
What testing will be implemented in order to confirm that a cure for HIV has been identified—and how will acceptance by the scientific community at large be confirmed?
We need highly sensitive tools to measure the size of the reservoir and its ability to actively replicate if antiretroviral therapy is withdrawn (as noted in the “roadblocks” section above). Once these tools have been developed and validated, we will be able to determine whether or not a person is cured. The ultimate tool to test a cure will be time, and it may take several years.
To date, there have been three landmark cases representing three types of cure: the Berlin patient, the Visconti cohort, and the Mississippi child. Are these cure methods not broadly applicable to others?
These approaches may not be broadly applicable, but we’re learning a lot from them that will help us find a cure that is broadly applicable. The Berlin patient required a stem cell transplant to treat his cancer (very unusual), and received cells from a donor with a genetic mutation that made him highly resistant to HIV infection (again, highly unusual). The VISCONTI cohort patients all started therapy within a few weeks of infection (very unusual) AND decided to stop taking therapy (highly inadvisable). The Mississippi child was born to a mother not in medical care (highly unusual) and was treated with a treatment dose of antiretroviral therapy within two days of birth (exceptional).
We’ve had many breakthroughs in HIV cure research over the last few years, but what about the setbacks, including Dr. Henrich’s patients, who appeared to be HIV-free following stem-cell transplants and later experienced a resurgence of virus? How do these events impact the current state of research?
Every piece of research, in a test tube or a patient, is an opportunity to learn what might work and what doesn’t work. In those cases where an intervention doesn’t work, we can learn why not and thus gain a better idea of what will work.
Clinical trials often take between eight and ten years to be completed. Is having a cure for HIV by 2020 even feasible?
Our goal is to achieve the scientific underpinnings of a cure by 2020. The likelihood is that, once we know what a cure looks like, it will be some time before it is thoroughly tested and then put into production. It is difficult to know how long that process will take.