International AIDS Society (IAS) Conference – Day 4

As I wrote on Monday, the excitement at the 2011 ISA conference are the conversation and reports about HIV prevention and the potential for a cure.  The day started with a presentation from the director of the US National Institute on Drug Abuse.  Injection drug use is the most commonly recognized drug use related vector for HIV transmission.  However, non-injecting drug use also increases the likelihood of HIV transmission. Data shows that the prevalence of HIV is as high in non-injecting drug users as it is in injecting drug users worldwide.  The reason is due to the physiological changes in the brain due to drug use and addiction.  Stimulation of the dopamine receptors in the brain (the reward center that promotes sexual arousal) together with inhibition in parts of the frontal lobe (the area of the brain we use to control our impulsive behaviors) are the result of drug use and abuse.  This combinatorial effect produces a propensity for injection and non-injection drug users to engage in high HIV risk sexual behavior.  In the context of a HIV prevention plan, this means we need to consider adequate attention and treatment for drug users in order to contain transmission and protect the general population.

The focus on a cure for HIV has stimulated a whole new field of scientific investigation.  It has recently been demonstrated that antiretroviral treatment is HIV prevention.  This is achieved by using highly active antiretroviral therapy (HAART) which is a combination of three different classes of ARVs simultaneously.  Results from HAART treatment show viral loads at undetectable levels.  Unfortunately, if HAART treatment is discontinued, viral load levels decrease to pretreatment levels within 14 days. This unfortunate result precludes the classification of HAART as curative.  It also begs the question, where does the viral load come from if HAART treatment is discontinued?  The answer to this question is ‘latent HIV reservoirs’. There are cellular ‘reservoirs’ of HIV hiding in different tissues.  The virus incorporates itself into the nucleus of several cell types, but does not replicate.  When these latent HIV reservoirs multiply they copy the integrated viral DNA.  Now, the hunt is on to find a method to stimulate viral transcription (replication) and thus elimination of the latent HIV reservoirs.  Current eradication strategies include small molecules that inhibit histone deacetylases, stimulation with cytokine IL-15, and activation of nuclear factor kappa B.

These past few days have been amazing, what a great conference! It all happens again in 2013 in Kuala Lumpur, Malaysia. I can’t wait to hear what has happened between now and then.  Perhaps we will have HIV efficacy data from Vitalwave to report.

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