Luis J. Montaner DVM, D.Phil, of the Wistar Institute in Philadelphia, Pennsylvania has been studying the effects of interferon on HIV DNA and its ability to reduce the size of HIV viral reservoirs for several years. The current understanding of HIV cure research is dedicated to the idea that viral reservoirs are the main barrier to eradicating HIV or producing HIV remission.
In February of 2014, The National Institutes of Health granted Montaner’s lab a four-year, $6.2 million grant to conduct a multi-site trial to investigate interferon. The study will be the largest clinical trial of a potential cure strategy to date, and continues earlier research of interferon that showed promising results.
Long acting parenteral (LAP) antiretrovirals (ARVs) are in development for both the treatment and prevention of HIV. It is estimated that the first LAP ARV could be available (most likely as PrEP) within five years. It is reported that combination ARVs that can be used as complete treatment regimens will take significantly longer to complete research and development and to be made available for use.
Pre-exposure prophylaxis (in the case of HIV) is when antiretroviral medications are taken before a possible exposure to HIV in order to reduce the risk of infection. Results with PrEP are mixed and appear dependent on the specific population tested, level of adherence and use of additional prevention methods such as condoms and HIV education and counseling. When taken as prescribed, study results show PrEP to be effective. However, daily adherence is a major road block to decreasing the risk of HIV infection through PrEP. As such, prescription of PrEP should be highly monitored and scrutinized.
What is PEP – PEP is when a short course of HIV antiretrovirals are given to someone following a possible exposure to HIV in order to decrease the risk of HIV infection. PEP consists of 3 or more ARV’s and is taken for 28 days. It is best to begin treatment as soon as possible after exposure, before the virus has time to replicate in the body. PEP must be started within 72 hours of exposure. Although PEP is not 100% affective, it dramatically reduces the chance of infection.
For someone who is HIV positive and in, or considering a sexual relationship with a positive person, the risk of HIV transmission is an important issue. In the summer of 2011, results from the HPTN 045 study were released stating that with an undetectable viral load, the risk of HIV transmission was decreased by up to 96%. Based on this study, and a few much smaller studies at the time, it seemed that the scarlet letter that was placed on HIV positive people as being infectious was lifted for the lucky ones who were able to achieve an undetectable viral load. However, many in the HIV professional field as well as HIV activists and advocates were reluctant to discuss the issue of a decrease in risk of transmission based on available research.
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