Mthe oysters of 50 years after leaping to the barrier of the species and becoming one of the most virulent viruses that affect humankind, HIV remains a stubborn opponent. Treatment has dramatically improved over the past 20 years, but people who are infected will stay alive throughout their lives and have to take one pill each day – one that was a cocktail of 30 years.
But now that another day of World AIDS is attracting, scientists are beginning to wonder if perhaps the biggest breakthrough – an exceptional remedy for tens of millions of people who have been infected – is in sight.
The excitement lies in research that has the success of drawing a virus from a latent stage (which can be undetected for a long time) so that it can be destroyed.
"The last few years have been very exciting on this front," said Satish Pillai, an associate professor of HIV research at the University of California at San Francisco. "We are now trying to find a holy grid of HIV research."
"First, we want to identify signature features, in a reliable and accurate way, of latent infected cells," Pillai said, referring to HIV-infected cells that avoid current treatments. "The other side is to develop new strategies to destroy them when we can identify them."
"We are entering a new era of finding a viral eradication drug," he explains.
The difficulty in fighting HIV once and for all is that, unlike other viruses, HIV-infected cells can "hide" by entering a rest period that makes them invisible to our immune system and current therapies.
These "latently infected" cells then exist in the reservoirs in the bodies of those who have a virus and can trigger new, resistant attacks if the treatment is interrupted.
Over the last few years, scientists have found that the destruction of the last stationary cell will be the future of treatment.
"People have long been looking for latency, which has become the focal point for the drug," said Dr. Jonathan Angel, head of the Department of Infectious Diseases at the Ottawa Hospital Research Institute.
"They've been working on HIV research for a long time, but it's just a recent change of tone."
"In my personal opinion, our therapies have become so good that looking at better therapies has become useless. People take the tablet once a day, without affecting the side. It's hard to improve."
In fact, increased antiretroviral efficacy has significantly stopped the mortality of the disease. The virus exists in around 36.7 million people around the world, and even though it killed about 1 million people in 2017 by UNAIDS, it represents a drop of almost 50% since 2005 when AIDS-related deaths were at its peak.
This is a reduction due to improved medicine, as well as logistics and patient awareness. But the virus remains a serious health problem in rural areas lacking those resources, especially in regions like Africa – more than a quarter of people in Swaziland have a virus.
Chronology of illness in some regions, huge cost and pressure on patients means that the drug is still an important goal. There are several different approaches that are currently being studied.
One approach, often referred to as "blow and murder" or "shock and murder", aims to suppress sleeping cells from sleep to be pointed and eliminated.
Sarah Fidler, a professor of HIV medicine at Imperial College London, recently conducted a major study of the effectiveness of the method of punching and killing, said: "The idea is to reactivate latent cells by starting to produce protein on their surface to look different from healthy cells. That's what we're going to do with some kind of drugs, and that's what we are in the process of determining. "
Another research approach wants to find and destroy HIV-infected cells while still in sleep.
The key to this will be to find something different about an infected, resting station – unlike healthy – so that an antiviral agent can target them. Scientists call this inescapable goal the biomarker.
There is promising work with antivirus viruses – viruses that are designed to target and destroy other viruses. The specific soybean, Rabbeovirus called Maraba virus (MG1), was designed to look for incorrect cellular communication, which is also the case with cancer and HIV. The difference that is small as this, between healthy and unhealthy cells, is sufficient for something like MG1 for targeting.
Angel says access to MG1 has only come about because of the physical closeness of scientists investigating cancer and HIV.
"The MG1 project has appeared on the side to be on the same floor as oncology, and watching seminars from guys in cancer research," said Angel. "There are viruses that can kill cancer cells based on the fact that interferon signaling is damaged [proteins made by cells to prevent virus replication], This is an innate antivirus molecule, present in all of our cells to protect viruses.
"We know that HIV can interfere with these paths, but what's not known is whether it is a case of latent infected cells because they appear so low in the body.
"MG1 as a potentially therapeutic agent that can be used by these cells".
Although there is consensus that destroying the reservoir of the virus is the next step, there are disagreements over whether this could be properly termed a drug, as we understand that term.
"Completely removing the HIV reservoir would have resulted in a drug. Unfortunately there may be something called" functional drug, "Angel said.
"This refers to the establishment of a condition where the immune system itself (without antiretroviral therapy) can control the virus so it can not be detected in the blood and has no effect on the immune system.
"Although the scientific community might consider this drug, the public might not," he said.
The speed of research is enabled by the advocacy community behind it, says Fidler. "It's a community of HIV people who have been an extraordinary driver in the research of the condition," she said. "No one has given up in our latest trial, which is practically unheard of."
"It's still a very stigmatic condition. People do not feel comfortable with it, as they could with diabetes or cancer," Fidler said.
"I think it's motivating that co-operation, people still feel that they are somehow different and that's what people do together, they're referring to these other people who have a virus, they are powerful advocates."
This article is part of the series about possible solutions to some of the most silent problems in the world. What else should we cover? Send us an email at email@example.com