This article is the first part of a two-part interview with Dr. Jeffrey Laurence, senior scientific consultant for the Foundation for AIDS Research, on the Foundation’s efforts toward a cure for HIV. Part 1 discusses the possibility of a cure and why it is necessary. Part 2 discusses the Foundation’s cure research and some promising avenues toward a cure.

When it was founded in 1985 by actress Elizabeth Taylor and scientist Mathilde Krim, the purpose of the Foundation for AIDS Research, known by its initials amfAR, was to determine how the virus worked and how to treat it. Today, 26 years later and 30 years after the AIDS epidemic began, that focus has turned specifically toward research for a cure – a goal that the foundation and many scientists believe is closer than ever before.

“I’d be tremendously disappointed if within 10 years we didn’t have something that was in large-scale clinical trials that looked like something that could cure AIDS,” said Dr. Jeffrey Laurence, senior scientific consultant at amfAR and a professor of medicine at New York Hospital-Cornell Medical Center in New York City.

“Perhaps not by itself but in conjunction with other modalities, that is, drugs for latency and so forth,” he added.

Dr. Laurence admitted that this is pure speculation – “It’s based on work I know is going on in mice and monkeys,” he said – but he is not alone in thinking that an end to the AIDS epidemic is in sight.

“The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now. And that is something we’ve never been able to say without qualification before,” said Secretary of State Hillary Clinton in a speech November 8 at the National Institutes of Health in Bethesda, MD.

In an interview with The AIDS Beacon, Dr. Laurence shared amfAR’s perspective on why a cure is necessary, why the Foundation is optimistic that a cure for HIV is on the horizon, and how amfAR thinks a cure might be achieved.

The Need For A Cure For HIV

One thing Dr. Laurence and amfAR are clear on is that a cure for HIV is, indeed, necessary.

In her speech last month, Secretary Clinton promoted several methods for creating an AIDS-free generation, including treating people with HIV earlier – which scientists have shown can make people less likely to pass the virus on to others – encouraging adult male circumcision, and making sure pregnant women with HIV receive antiretrovirals to prevent transmission of the virus to their babies.

The problem, said Dr. Laurence, is that these measures alone will not be enough.

“It’s absolutely fine to do all the measures that Secretary Clinton suggested, and they’re important and they should be done, but they’re going to cost a tremendous amount of money, and it’s unclear that there’s the will, certainly right now, in federal governments and international governments, to pay for it,” he said.

According to amfAR’s estimates, antiretroviral therapy costs $600,000 or more over a person’s lifetime. In addition, said Dr. Laurence, two and a half people currently get infected for every one person who starts antiretroviral therapy.

Another factor working against eliminating HIV with the current treatment paradigm is that antiretroviral therapy requires strict adherence, or a person’s HIV will become resistant to the drugs. Many people have a difficult time committing to a lifetime of perfect adherence to a drug regimen, particularly when many of those drugs have long-term side effects, said Dr. Laurence.

“All of [these things] mean that if we could have a one-shot approach to a cure for HIV – we’re nowhere near that yet – it would be a tremendous step towards reaching that goal of Secretary Clinton, an AIDS-free world.”

A Cure For AIDS: Phantom Or Reality?

This is not the first time, however, that scientists have claimed to be close to a cure for HIV.

“For the longest while, certainly in the AIDS advocacy community, and perhaps in the federal government, cure was a four-letter word,” said Dr. Laurence.

“False hopes had been raised in the past, initial studies and some scientists saying that you can cure AIDS in two or three years with these highly potent antiviral drugs, and the rest of the virus-infected cells will just die off. It turned out not to be true,” he said.

Those early hopes that antiretroviral therapy might cure HIV turned out to be overly optimistic. Instead, scientists discovered that even when it is not detectable in the blood, HIV hides out in the cells it infects as a dormant form called latent HIV.

Since this HIV is not actively replicating, it is not affected by antiretrovirals, which means that they cannot cure the disease. As soon as antiretrovirals are stopped, the virus begins replicating again, multiplying from those hidden reservoirs of latent HIV.

Today, the approach to a cure is more realistic, because scientists acknowledge that curing HIV is more challenging than expected. In addition, scientists today have something they did not have when they first starting work on a cure – one patient who has, in fact, been cured.

“The good news is that since we have the one proof of concept from the Berlin patient, AIDS advocates have come around to the fact that this is now possible [to cure HIV], it’s not a pipe dream, it’s been done once. Let’s do it again, in a different way,” said Dr. Laurence.

The Berlin patient, Timothy Ray Brown, has been HIV-free since receiving a bone marrow stem cell transplant in 2007 to cure his leukemia. Sensing an opportunity, his doctors chose a stem cell donor with a genetic mutation – present in about 1.5 percent of the Caucasian population – that makes people resistant to HIV.

The transplant worked, and Brown has tested negative for HIV ever since. While the approach is not safe or practical for widespread use – “Upwards of 18 percent of people are going to die in the first 100 days from the transplant, you’d never do it for HIV itself,” said Dr. Laurence – the fact that it worked means that HIV can, in fact, be cured.

Such a feat, said Dr. Laurence, gives scientists hope. “I think there will be a cure in my lifetime. I just don’t know what that cure looks like yet,” he said.

For more information on HIV cure research, please see The AIDS Beacon’s series on Advances And Barriers To A Cure For HIV.