Washington — A new year will begin at the National Institute of Allergy and Infectious Diseases (NIAID) with an intensified focus on finding a cure for HIV, the virus that causes AIDS.
President Obama announced in early December that the agency should redirect $100 million in funding to accelerate the search for a cure. HIV treatment has become very effective in controlling the virus in infected persons, but it never eradicates the virus completely, and it still has drawbacks.
The medications are very expensive, they can have serious side effects, and lifetime distribution to all persons around the world living with HIV/AIDS is an enormous challenge.
"It may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy," said NIAID's director, Dr. Anthony Fauci.
A cure has eluded medical science from the beginning of the pandemic, but more than 30 years of research have produced some promising avenues of investigation for a cure.
"The time is ripe to pursue HIV cure research with vigor," Fauci said at a World AIDS Day White House briefing December 2.
Jack Whitescarver, director of the Office of AIDS Research at the National Institutes of Health (NIH), explained the future research will focus "specifically toward the goal of sustained or lifelong remission, in which patients control or even eliminate HIV without the need for lifelong antiretroviral therapy."
The search for a cure is targeting several different lines of inquiry. Developing a greater understanding of how the virus replicates itself while living inside a person, and how it progresses at the cellular level, is one way researchers want to better understand HIV.
Locating what researchers call the "reservoirs" of virus in the body is another goal for the near term. Treatment with antiretroviral medications (ARVs) continues for a lifetime because the virus returns if the medicine is stopped. The patient may have seemed clear of the virus while on ARV, but science has determined that HIV finds some place in the tissues to hide from the medication.
"So we need to study the nature of this particular reservoir of virus," Fauci said in a radio interview, "and try to remove it either by a new class of drugs, by activating it or stimulating it to express itself so we can get rid of it."
Further understanding of HIV reservoirs may lead to new ways to treat and prevent HIV. New research will also be directed to broadening knowledge of how HIV might be inhibited and how the immune response is activated.
The new funding investments will involve thousands of physicians and scientists at universities and biomedical centers, nationally and internationally, Fauci said. Study will also be directed toward understanding the interaction of aging and HIV infection, and what happens when HIV-induced immune dysfunction coexists with conditions of aging such as cardiovascular disease and frailty.
Finding a cure for HIV is among the greatest biomedical challenges of the age, but Fauci cautioned anyone from believing that a cure is close at hand. Science is an incremental process that relies on the peer review process to build knowledge over time to ultimately develop answers, he said. The $100 million investment announced by the White House will help make progress toward a cure, but cannot guarantee it.
NIH's director, Dr. Francis Collins, said that this new commitment to investment in AIDS research comes in the aftermath of a difficult period in the research community brought on by U.S. government budget difficulties. This investment marks a way forward.
"AIDS research is an example of an area where hard-won progress over many years has resulted in new and exciting possibilities in basic and clinical science in AIDS that must be pursued," Collins said.