It is estimated that in Spain between 140,000 and 170,000 people live with HIV. The most worrying fact is that one in seven is unaware that they have this disease. In 2021 alone, in the midst of the coronavirus pandemic (taking into account under-reporting), 2,786 new cases were diagnosed.
Men account for 86.1% of new diagnoses of and the corresponding rates for men and women they were 10.3 and 1.6/100,000 respectively.
Transmission in men who have sex with men (MSM) was the most frequent, 56.3%, followed by heterosexual transmission, which accounted for 25.4%, and that which occurred in people who inject drugs. Among women, heterosexual transmission constitutes the vast majority, with 79.9% of new diagnoses.
During the eighth edition of the HIBIC (Milestones in Basic & Clinical Research in HIV/AIDS) organized by Gilead in Madrid, more than 400 experts in HIV management have discussed the latest advances in research, epidemiology and clinic of the infection .
This meeting was coordinated by doctors José Alcamí, from the National Center for Microbiology, Santiago Moreno, from the Ramón y Cajal University Hospital in Madrid, José Ramón Arribas, from the La Paz University Hospital in Madrid, and Josep María Llibre, from the Germans University Hospital Trias i Pujol from Badalona.
This is a meeting that has already become a fixed high-level medical appointment in which prestigious experts such as the Dr. Mathias Lichterfelwith whom we have spoken in ‘Health Guides’ to shed light on the possible cure for the disease.
An infectious disease physician, Dr. Lichterfeld works as a basic and translational science researcher, clinical care provider, and mentor and educator to clinical and research residents and fellows.
He is Professor of Medicine at Harvard Medical School and Co-Director of the Center for HIV Eradication Research (CFAR) Program at Harvard University.
What are the main challenges in the field of reservoirs and what kind of advances do you foresee in the near future? What are the pending challenges?
HIV reservoir cells are HIV-infected cells that persist for life despite highly effective antiretroviral therapy.
A key challenge is understanding how these cells manage to survive all these years and resist being killed off by host immune responses. An important mechanism that allows these cells to persist is “viral latency.”
By this term we refer to the fact that these cells are not producing any virus and are in a “sleeping” state – thus, the infected cells are not visible to the immune system. It is likely that there are additional mechanisms that contribute to the persistence and resistance of these cells; this is a high priority area of current research.
Is early therapy the key to limiting the size of the reservoirs?
It probably is: several studies indicate that the frequency of infected cells is lower when treatment is started early. That said, it is well established that the size of viral reservoirs varies profoundly among people living with HIV, and early initiation of treatment may be just one of many other important factors.
In recent weeks, and with the contribution of the Spanish research team, a protein has been identified that helps the virus remain latent. Do you consider this a step towards a cure?
I assume you are referring to the report by Kobayashi-Ishihara et al. (Com Bio 2023). This is a very interesting report that suggests that a human protein, called “Schlafen 12”, helps to suppress the expression of the HIV-1 protein and keeps HIV in a latent state, where it is invisible to host immune responses.
I believe this type of research is essential to better understand how HIV reservoir cells are able to resist elimination by the human immune system.
At what stage is the search for an HIV cure?
In recent years, much progress has been made in analyzing HIV-1-infected cells in much greater detail, particularly through the use of new next-generation sequencing technologies that can analyze individual HIV-1 genomes and individual infected cells. by HIV isolated from HIV-positive people.
At the same time, advances in cure research have been catalyzed by recent descriptions of people who developed a cure of HIV infection after transplantation of hematopoietic stem cells carrying the CCR532 mutation.
Progress is also being made in understanding the mechanisms underlying the spontaneous control of HIV in so-called “elite controllers”, that is, people who maintain an undetectable HIV viral load in the absence of antiretroviral therapy.
Overall, the progress is exciting, and I remain optimistic that all of this research will ultimately help develop a cure for HIV infection.
What are the main objectives on which you are currently focusing your efforts to take a step towards the eradication of HIV infection?
Our work focuses on understanding HIV-infected cells from HIV-positive people at the molecular level. We are trying to understand in great detail how these infected cells differ from uninfected ones, and we hope that this information can help us develop interventions targeting them in clinical settings.
We work with all age groups, from newborns to the elderly, and we are incredibly grateful to all the people living with HIV who participate in our studies and are instrumental in advancing HIV cure research.