“The way HIV cure would happen is that we would start with ARV so when the viral load is down, you knock them down” “The issue of taking the current drugs for life isn’t even a patient issue but a donor-and-government issue because there may not be resources to sustain that” There is optimism in the top HIV researchers in the world that a cure is imminent. The current treatments help a lot, but it has been a long aspiration to find a cure. The two recent breakthroughs represent a significant milestone. Until today, there are only two people and several mice that are known to have been cured of HIV. However, there is growing optimism that these breakthroughs will lead to a new way of eradicating the virus without the need for further treatment. “We now have very good understanding of why the virus keeps evading the antiretroviral therapy and we know where it hides”, says Dr Peter Cherutich. Dr Cherutich is a celebrated Kenyan public health specialist and an HIV researcher. He is the first graduate of the Ph.D. programme in global health metrics and evaluation at the University of Washington in 2015. The university awarded him the prestigious Gilbert S Omenn Award, for his academic excellence and commitment to public health. In 2016, a study he conducted in Kenya helped the World Health Organisation’s HIV self-testing and assisted partner notification guidelines. Dr Cherutich took part in the exclusive Sunny Lands Summit this year, where some of the world’s top researchers described how a future HIV cure might look like, its cost and delivery. He spoke to the Star on the ongoing global efforts to find a cure for HIV. “There are two things that are related. One is it has always been the aspiration of the global community, of advocates and researchers, to find a cure. From day one, we knew that was where the journey would end. Treatments are just intermediate, not the final solution. Treatments help a lot, but the goal has been to find a cure. The two cases represent a significant milestone. In the last three years, the milestone for a cure has gone up sharply because we have an idea of what would lead to a cure. Antiretroviral therapy does not eliminate the virus from the body completely because the virus hides in some cells, where ARVs don’t reach. They can only clear what is in the blood. The way HIV cure would happen is that we would start with ARV so when the viral load is down, you knock them down. Then you still keep someone on antiretroviral for some time as you monitor. There is proof this mutation can be engineered to make the cell become immune to HIV infection. In the entire bloodstream, to find those infected cells that are hiding takes a lot of time, because they are also very few The second part is there are 30 million-plus (37 million, according to UNAIDS) people with HIV across the world. We can put everyone on ART and incidence will go down, and people will have a normal life expectancy. But the amount of dollars we need to put all these people on treatment for life is too much, so we have sufficient motivation to find treatment. We now have a very good understanding of why the virus keeps evading the antiretroviral therapy, and we know where it hides. We have proof of concept that cure is possible. If you follow both the Berlin and London patients, the thread is similar. If you have a mutation to the gene CCR5 gene, you can’t get HIV; it cannot attach to the cell and so it will be knocked off by ARVs. The medicines are always circulating in the blood but the ARVs cannot recognise or enter into some of those cells. When a virus has entered a cell, sometimes this cell exposes itself to white blood cells and is killed together with the virus. So sometimes, these hijacked cells hide. It’s like if someone is hijacked by thugs; sometimes they can’t alert cops in case they are shot along with the hijackers. There is proof this mutation can be engineered to make the cell become immune to HIV infection. In the entire bloodstream, to find those infected cells that are hiding takes a lot of time, because they are also very few. It could mean one infected cell in a million cells. So if you miss that one and discontinue ART, that one cell will come out and the virus will spread. People with CCR5 mutation can get still infected but the virus has nowhere to hide, so ART will come and kill them.” The Sunny Lands Summit, held in California, also considered how to ensure the widest possible distribution and access for a future cure. While a cure will be essential worldwide, the primary focus of the discussion was the challenge of distribution in low and lower-middle-income countries, particularly in sub-Saharan Africa. What would be the most effective way to deliver a cure? What’s the cost? “The issue of taking the current drugs for life isn’t even a patient issue but a donor-and-government issue because there may not be resources to sustain that. You can imagine how much it would cost to put 30 million people on treatment. It would cost trillions of dollars. But compare that with investing in 10 to 15 years in research, productions, and manufacturing; it will be cheaper. The search for HIV cure is a cheaper, better and prudent use of money. But for now, ARVs are important to save lives.” Now there is optimism in the top HIV researchers in the world to cure this lethal disease. There is the hope of new life in the world. The writer is a retired doctor of the Sindh Health Department