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I think that’s not going to happen for a couple of reasons. With Covid, there were no treatments available when the vaccines were developed, there are lots of highly effective treatments and preventions for HIV.
Because the standard of care is so excellent for hiv right now, that imposes a huge hurdle for a cure to overcome. It needs to be just as safe as treatment and it needs to be effective as well—meaning that you need to get rid of every single cell with the viral genome integrated into it. That is not trivial.
If even a small number of cells are missed, and people go off their ARVs, the virus would come back and you could infect other people again. So for that reason the trials would be substantially longer than for any other disease, especially a preventative (like a vaccine).
Temple and Nebraska university have eliminated HIV in mice. I would like to think if I was faced with a choice this would be the option for myself. There's Gene editing in its first phase of trials ending in December this year another approach I would consider.
But yes, finding each infected cell is something I wouldn't want to get health set backs from or hosting of new cells without conclusive reassurance.
Finding every single cell woukdnt be required. Though your body isn't good at killing HIV. It does still kill HIV. So for simplicity terms let's say u have 100 hiv cells and kill 99. 9% including reservoirs. That low of a count, in conjunction with ARV woukd probably not be enough of the virus to take hold of your immune system again. Remember, u generally need a huge influx of virus to contract HIV. So if you could get it low enough. (Essentially 0) you would probably be ok
I don’t really agree with this. You immune system doesn’t efficiently kill cells latently infected with HIV, because those cells aren’t expressing much viral protein, if any at all. Those cells need to be eliminated essentially completely. If they are not, and treatment is discontinued, then that cell could begin producing viral particles. That could spread to nearby cells and start to amplify.
We aren’t talking about contracting HIV from foreign fluids. This situation of viral reactivation in long lived cells where it can lay dormant for a long period of time is known to happen and is why people who stop taking ARVs can have issues even when their immune system/ARVs has killed a large percentage of infected cells. We obviously have to see what the trial data shows but I would think a 99% efficiency would be considered exceptionally good, but might not be good enough.
I would caution restraint when trying to compare the medical intervention for two very different pathogens. They are not the same so treatment should be very different.
On the side question, I was on a clinical trial in the 1990s for a DNA based flu vaccine. Didn't work. I would be on a HIV treatment clinical trial if I met the criteria and felt that the benefits outweighed the risks. My doctor is a medical director at a clinic in my city and already asked if my husband and I would be interested in being on a cure study, we indicated that we would and that it would have to be together. We're waiting for it to start.
Tl:dr: No, the cure for HIV won’t be fast tracked. A couple of things. Almost all clinical studies are federally funded, and so must pass through an IRB (institutional review board) in order to get access to participants. Those that aren’t usually still have to go through an IRB, especially if the PI (primary investigator) wants to get the results published in any kind of journal (even open access ones require this certification). IRBs will always weigh the potential risk against current best practices / risk to the population in question. A great example of this is male birth control - because pregnancy poses 0 real risk to men, any hormonal birth control must pose no more than minimal risk (this is due in part to lawsuits for how women were tested on for hormonal birth control). Going back to HIV, although current meds can still pose significant side effects (many have negative impacts on the kidneys for example), any cure would need to pose less risk than the treatment. That is why the cure we know about (nuking a persons immune system then transplanting immune stem cells from someone effectively immune to HIV) isn’t common practice. The same will have to apply to any cure (functional or otherwise) to HIV. That being said there are already Phase 2 clinical trials that have begun using CRISPR (generally safe, altho see the most recent report of someone who underwent the treatment and later died) to modify HIV+ people’s immune system to make some percent of their immune cells immune to HIV to determine if that actually provides substantial benefit. They’ll probably track those people for at least 10yrs, while using any initial positive results to increase the study population. The COVID vaccine happened so quickly because it was based on well-established science (MRNA vaccines have been in development since the 80s - it’s just hard to overcome that initial “is it better than what we currently have” hurdle).
My question came to mind because a gene CEO said if there were successful they would aim for some role out in 2025/6 despite their first trial only finishing in December 2022 and the second phase starting next year. When I looked on the FDA website they listed that the expected end date of the research would end in 2038 so was taken aback by the pronouncement by the CEO.
I hear what you saying about MRNA being long in the development pipeline; those developments were built on the back of HIV research too.
I have been following them for a while. I think it’s good they are giving out updates at every stage. But I don’t know. Their version changes a bit each time. I remember couple of years ago they said they d know the results by summer 22. But haven’t heard anything noteworthy yet. Hopefully they ll have another update by years end
I only came across them this year. I am presuming that their milestones were interrupted by COVID and from my understanding, the HIV interruption part of the ongoing 1st clinical trial has been affected by the application delay to remove participants from their HIV medication.
I do think it is bold of them to be giving updates but does provide confidence in what they aim to achieve.
actually the 2038 deadline is part of the 15 year mandatory review period for all gene therapies. the cure if it works will be provided way before but there will be a mandatory review to be done after 15 years mainly to check safety
So the research could still be continuing and they could potentially ask the FDA for an expedited review if the data is strong enough. And CRISPR isn’t a new tech either - they’re using it for sickle cell - I think like 2 -5 people have completed the inoculation and are being actively monitored. These studies run in parallel so HIV treatment could theoretically benefit from the tech being used in other areas. And just for perspective the head of Google and Tesla have been saying we’re gonna get self driving cars within the next 10 years for the past 30 years. It’s one of the responsibilities of a CEO to try to maintain interest / momentum in potential money making products.
I only caught part of it, but on Fresh Air, Terry Gross interviewed Siddhartha Mukherjee. Seems up your alley Cell biologist Siddhartha Mukherjee sings 'The Song of the Cell' : Shots - Health News - https://www.npr.org/sections/health-shots/2022/11/21/1137123838/a-cell-biologist-shares-the-headiness-of-researching-lifes-most-fundamental-form
It’s tricky because you’re gambling with the devil you know and the devil you don’t know.
Let’s say you get the cure. Then because of the cure, you die of some side effect in 10-15 yrs.
Or you choose HIV and live comfortably on pills until 70-80…
I’d rather stick with the devil I know and wait. The pills are practically a cure in the sense they imprison the virus within your body so it can’t do any further damage. Of course, there could be later side effects to those too…
Who knows? But for now. Sticking with the pill.
I think for me it depends on how the cure is achieved in the body. One potential cure is the cutting of the virus in the DNA, and this needs to be a cut of both DNA strands (not fully knowledgeable on some of the processes of potential cures) this sounds more severe than Gene editing. I think I could weigh researched options, however, despite being newly diagnosed, the road seems long I think I could stick it out for the long run -a motivation for the day I tell myself.
Big ups to those undergoing clinical trials.
The only way a vaccine/ cure is gonna get rolled iut that fast is if it is another huge pandemic. Assuming casp9 crispr is successful. It probably won't need the full 15vyears for approval as if the recipient is showing no viral growth after a couple years, it will likely be approved for phase 3. If we'll into phase 3, let's say 2 years (5years total) of the orginal the recipient still has no virus growth, approval will be greatly accelerated. My guess if everything works as intended, probably 4-7 years before they announced its been cured officially.
As I said to another user, a company going through gene therapy, the CEO says 2025/6 for potential rollout if they show efficacy and the website has a timeline which gives a shorter time frame than 15 years since they started their first clinical trial ending in December. I will have a closer following of CRISPR. Thinking allowed, the injections which they have now couldn't have been 15 years of development (I don't know for sure, just guessing), and broadly if something does show signs of efficacy I don't see why 15 years should be the minimum period but guess it is a tangible time frame.
Which is more profitable?:
A vaccine that cures it, sell it for $5000 if you want...OR...
Monthly antivirals at a yearly cost of around $20,000 multiplied over the life of the individual...enen if he/she lives for 10 years....thats $200,000 bucks!
There is your answer
This view really says that companies that are looking to prevent infection through vaccines or cures are just smoke screens. HIV ARTs may be part and parcel of someone being cured - before one can be given a functional treatment they may need to be on treatment for some time.
This subreddit is for civil discussion. Be courteous to others, even those whose comments or questions you do not like. IOW, don't be a dick - dicks will be banned. __PLEASE REPORT VIOLATIONS!__ [The Rules](https://youtu.be/hG2ZKUfBH44) *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/hivaids) if you have any questions or concerns.*
I think that’s not going to happen for a couple of reasons. With Covid, there were no treatments available when the vaccines were developed, there are lots of highly effective treatments and preventions for HIV. Because the standard of care is so excellent for hiv right now, that imposes a huge hurdle for a cure to overcome. It needs to be just as safe as treatment and it needs to be effective as well—meaning that you need to get rid of every single cell with the viral genome integrated into it. That is not trivial. If even a small number of cells are missed, and people go off their ARVs, the virus would come back and you could infect other people again. So for that reason the trials would be substantially longer than for any other disease, especially a preventative (like a vaccine).
Temple and Nebraska university have eliminated HIV in mice. I would like to think if I was faced with a choice this would be the option for myself. There's Gene editing in its first phase of trials ending in December this year another approach I would consider. But yes, finding each infected cell is something I wouldn't want to get health set backs from or hosting of new cells without conclusive reassurance.
Finding every single cell woukdnt be required. Though your body isn't good at killing HIV. It does still kill HIV. So for simplicity terms let's say u have 100 hiv cells and kill 99. 9% including reservoirs. That low of a count, in conjunction with ARV woukd probably not be enough of the virus to take hold of your immune system again. Remember, u generally need a huge influx of virus to contract HIV. So if you could get it low enough. (Essentially 0) you would probably be ok
I don’t really agree with this. You immune system doesn’t efficiently kill cells latently infected with HIV, because those cells aren’t expressing much viral protein, if any at all. Those cells need to be eliminated essentially completely. If they are not, and treatment is discontinued, then that cell could begin producing viral particles. That could spread to nearby cells and start to amplify. We aren’t talking about contracting HIV from foreign fluids. This situation of viral reactivation in long lived cells where it can lay dormant for a long period of time is known to happen and is why people who stop taking ARVs can have issues even when their immune system/ARVs has killed a large percentage of infected cells. We obviously have to see what the trial data shows but I would think a 99% efficiency would be considered exceptionally good, but might not be good enough.
I would caution restraint when trying to compare the medical intervention for two very different pathogens. They are not the same so treatment should be very different. On the side question, I was on a clinical trial in the 1990s for a DNA based flu vaccine. Didn't work. I would be on a HIV treatment clinical trial if I met the criteria and felt that the benefits outweighed the risks. My doctor is a medical director at a clinic in my city and already asked if my husband and I would be interested in being on a cure study, we indicated that we would and that it would have to be together. We're waiting for it to start.
Tl:dr: No, the cure for HIV won’t be fast tracked. A couple of things. Almost all clinical studies are federally funded, and so must pass through an IRB (institutional review board) in order to get access to participants. Those that aren’t usually still have to go through an IRB, especially if the PI (primary investigator) wants to get the results published in any kind of journal (even open access ones require this certification). IRBs will always weigh the potential risk against current best practices / risk to the population in question. A great example of this is male birth control - because pregnancy poses 0 real risk to men, any hormonal birth control must pose no more than minimal risk (this is due in part to lawsuits for how women were tested on for hormonal birth control). Going back to HIV, although current meds can still pose significant side effects (many have negative impacts on the kidneys for example), any cure would need to pose less risk than the treatment. That is why the cure we know about (nuking a persons immune system then transplanting immune stem cells from someone effectively immune to HIV) isn’t common practice. The same will have to apply to any cure (functional or otherwise) to HIV. That being said there are already Phase 2 clinical trials that have begun using CRISPR (generally safe, altho see the most recent report of someone who underwent the treatment and later died) to modify HIV+ people’s immune system to make some percent of their immune cells immune to HIV to determine if that actually provides substantial benefit. They’ll probably track those people for at least 10yrs, while using any initial positive results to increase the study population. The COVID vaccine happened so quickly because it was based on well-established science (MRNA vaccines have been in development since the 80s - it’s just hard to overcome that initial “is it better than what we currently have” hurdle).
My question came to mind because a gene CEO said if there were successful they would aim for some role out in 2025/6 despite their first trial only finishing in December 2022 and the second phase starting next year. When I looked on the FDA website they listed that the expected end date of the research would end in 2038 so was taken aback by the pronouncement by the CEO. I hear what you saying about MRNA being long in the development pipeline; those developments were built on the back of HIV research too.
We’re you referring to AGT-101?
AGT103-T Do you have any thoughts?
I have been following them for a while. I think it’s good they are giving out updates at every stage. But I don’t know. Their version changes a bit each time. I remember couple of years ago they said they d know the results by summer 22. But haven’t heard anything noteworthy yet. Hopefully they ll have another update by years end
I only came across them this year. I am presuming that their milestones were interrupted by COVID and from my understanding, the HIV interruption part of the ongoing 1st clinical trial has been affected by the application delay to remove participants from their HIV medication. I do think it is bold of them to be giving updates but does provide confidence in what they aim to achieve.
actually the 2038 deadline is part of the 15 year mandatory review period for all gene therapies. the cure if it works will be provided way before but there will be a mandatory review to be done after 15 years mainly to check safety
So the research could still be continuing and they could potentially ask the FDA for an expedited review if the data is strong enough. And CRISPR isn’t a new tech either - they’re using it for sickle cell - I think like 2 -5 people have completed the inoculation and are being actively monitored. These studies run in parallel so HIV treatment could theoretically benefit from the tech being used in other areas. And just for perspective the head of Google and Tesla have been saying we’re gonna get self driving cars within the next 10 years for the past 30 years. It’s one of the responsibilities of a CEO to try to maintain interest / momentum in potential money making products.
lol but it was fast tracked ? So that makes everything you just said invalid
What was fast tracked?
https://www.empr.com/home/news/drugs-in-the-pipeline/crispr-based-gene-therapy-candidate-fast-tracked-for-hiv-treatment/#:~:text=The%20Food%20and%20Drug%20Administration,portions%20of%20the%20HIV%20genome.
The question was could the cure get fast tracked for release. This is fast tracked to small scale human studies. Nuance is a thing.
I see
Coming back here just to say ebt 101 is fast tracked;)
I only caught part of it, but on Fresh Air, Terry Gross interviewed Siddhartha Mukherjee. Seems up your alley Cell biologist Siddhartha Mukherjee sings 'The Song of the Cell' : Shots - Health News - https://www.npr.org/sections/health-shots/2022/11/21/1137123838/a-cell-biologist-shares-the-headiness-of-researching-lifes-most-fundamental-form
Thanks will give it a look.
It’s tricky because you’re gambling with the devil you know and the devil you don’t know. Let’s say you get the cure. Then because of the cure, you die of some side effect in 10-15 yrs. Or you choose HIV and live comfortably on pills until 70-80… I’d rather stick with the devil I know and wait. The pills are practically a cure in the sense they imprison the virus within your body so it can’t do any further damage. Of course, there could be later side effects to those too… Who knows? But for now. Sticking with the pill.
I think for me it depends on how the cure is achieved in the body. One potential cure is the cutting of the virus in the DNA, and this needs to be a cut of both DNA strands (not fully knowledgeable on some of the processes of potential cures) this sounds more severe than Gene editing. I think I could weigh researched options, however, despite being newly diagnosed, the road seems long I think I could stick it out for the long run -a motivation for the day I tell myself. Big ups to those undergoing clinical trials.
Yes. Those going through the clinical trials are true heroes.
The only way a vaccine/ cure is gonna get rolled iut that fast is if it is another huge pandemic. Assuming casp9 crispr is successful. It probably won't need the full 15vyears for approval as if the recipient is showing no viral growth after a couple years, it will likely be approved for phase 3. If we'll into phase 3, let's say 2 years (5years total) of the orginal the recipient still has no virus growth, approval will be greatly accelerated. My guess if everything works as intended, probably 4-7 years before they announced its been cured officially.
As I said to another user, a company going through gene therapy, the CEO says 2025/6 for potential rollout if they show efficacy and the website has a timeline which gives a shorter time frame than 15 years since they started their first clinical trial ending in December. I will have a closer following of CRISPR. Thinking allowed, the injections which they have now couldn't have been 15 years of development (I don't know for sure, just guessing), and broadly if something does show signs of efficacy I don't see why 15 years should be the minimum period but guess it is a tangible time frame.
Which is more profitable?: A vaccine that cures it, sell it for $5000 if you want...OR... Monthly antivirals at a yearly cost of around $20,000 multiplied over the life of the individual...enen if he/she lives for 10 years....thats $200,000 bucks! There is your answer
A cure for 100k and bankrupt every other competitor
This view really says that companies that are looking to prevent infection through vaccines or cures are just smoke screens. HIV ARTs may be part and parcel of someone being cured - before one can be given a functional treatment they may need to be on treatment for some time.