At first, in the medical fight against AIDS, there was only uncertainty.
Then researchers brought hope in the form of life-saving treatment - antiretrovirals that stop HIV from replicating in an infected person and reduce the risk of transmission.
Now, as the international community marks World AIDS Day on Dec. 1, a cure could be within REACH.
Western University researcher Jessica Prodger is a collaborator in Research Enterprise to Advance a Cure for HIV (REACH), an ambitious multi-institutional project funded through the U.S. National Institutes of Health (NIH).
HIV is resilient and has, so far, been resistant to a cure. One key issue is that some of the virus, as it integrates itself into human DNA, becomes invisible to the immune system if the infected cells go dormant. But the cells retain the viral DNA, and if a person stopped taking antiretroviral treatment, the infection would reactivate and the virus would again replicate.
The work of REACH focuses on understanding this latent "reservoir" of infected cells and figuring out how to eliminate it.
Jessica Prodger, Schulich School of Medicine & Dentistry
Prodger, a professor of immunology and microbiology at Western's Schulich School of Medicine & Dentistry, is a co-lead investigator in Weill Cornell Medicine's new five-year, US$28.5 million Martin Delaney Collaboratory grant from the NIH.
"This is a huge endeavour involving 37 co-investigators, all of us attacking HIV from one important angle," Prodger said. "The NIH Martin Delaney funding removes competition between individual groups, allowing us to organize cure research into large, well-funded teams, and I think we're going to make huge strides."
Her research includes a study group of HIV-positive women and men in Uganda who are receiving antiretroviral therapy.
Her team has been tracking and quantifying the HIV reservoir in this cohort, and has made important discoveries, such as that latent HIV is not as easily reactivated in females.
It's one small, but vital, part in solving the larger HIV puzzle and finding a cure, said Prodger, who also holds a Canada Research Chair in genital immunology and prevention of sexually transmitted infections.
Burden of infection
Around the world, 38 million people live with human immunodeficiency syndrome (HIV) and require daily, lifelong medication.
In 2020 alone, about two million people contracted HIV and 690,000 died from AIDS-related illnesses, UNAIDS notes.
All told, 80 million people have contracted the virus; half of those have died from AIDS-related illnesses.
The heaviest burden of infection is still borne by people in low-income countries where different strains of HIV are in circulation, while most of the research is taking place in high-income countries among high-income populations with predominantly one HIV strain.
Shifting focus
But progress is taking place.
AIDS-related deaths have dropped by 64 per cent since the peak in 2004. Infection numbers last year were about half the number of infected in 1997.
Antiretrovirals and other medications are transforming HIV infection into a manageable chronic condition, and people who are on effective treatment cannot transmit the virus to others.
Scientists around the world, including many at Western, are working towards new treatments, cures and potential vaccines.
"The focus of HIV research for the first 30 years (since HIV was first identified) was on treatment and prevention, to save lives and stop people from dying of AIDS. This has been hugely successful," Prodger said. "The discovery of the reservoir came decades after the discovery of the virus, and the field has only just begun to focus on a cure, now that highly effective treatments have been developed."
The REACH team is composed of investigators with expertise in virology, immunology, clinical studies and community advocates.
With 18 different institutions involved, the REACH program is a model for harnessing the great power of many scientific communities and minds, said a news release from Weill Cornell Medicine, based in New York.
The project team, led by Dr. Brad Jones, associate professor of immunology in medicine in the Division of Infectious Diseases at Weill Cornell Medicine, received the Delaney Collaboratory grant in August 2021. The REACH Collaboratoryis co-led by Dr. Marina Caskey of The Rockefeller University.
"This award represents a remarkable vote of confidence and recognition of Weill Cornell Medicine as an international hub of HIV cure research," Jones said in the news release. "With this funding we will leverage novel technological and analytical methods to redefine how the immune system interacts with the HIV reservoir in people on therapy."
A cure - either eradicating the virus in the body or suppressing the virus by boosting the immune system - would end the need for lifelong medication. "We believe that both of these outcomes are possible, but that they are complex and there are challenging problems to solve," Jones said.
Prodger emphasized it's the collaboratory's collective work, not any one individual's, that will make the difference and, ultimately, lead to a cure.
"Research is very much about building an enormous structure, brick by brick. You begin to see what an amazing thing this is when everyone adds their brick to the whole," she said.
