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NIH Cure Meeting - overview by Dan Kuritzkes /Cure Research direction - Concerns, questions, treatment interruptions
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Jules Levin
NATAP
Yesterday I sent you my report on the OAR Cure meeting which followed directly after the 3 day NIH Cure Research meeting. Dan's talk on day 2 of the 3 day NIH meeting was a little more expansive and worth listening to. He reviews the cure research types of drugs being looked at. Of note he raises the issues of safety and treatment interruption upon which he seems to sound the same concern I raised years ago when treatment interruptions first became "hot" and also when they started to be inserted in cure research when cure research first started several years ago.
LINK TO NIH WEBCAST & Dan's talk:
https://videocast.nih.gov/summary.asp?Live=20242&bhcp=1
Link to:
OAR Webcast: https://videocast.nih.gov/summary.asp?Live=20129&bhcp=1
So what are the risks of treatment interruption:
interruption risks - reseeding reservoirs, stimulalting inflammatuion and affects on comorbidities including the brain, what is affect of turning virus on and off? Even if a cure were found tomorrow we do not know how this will affect older aging patients & the inflammation & comorbidities they have ongoing. I maintain a cure WILL NOT reverse the inflammation & damage already occurred over 10-20 or 30 years of HIV infection, and perhaps the known or unknown long term toxicities of ART. These are NOT KNOWN, we do not know how an interruption might affect these. And Dan also mentions risk for HIV transmission. Safety is a concern of mine and mentioned by Dan where in his talk he refers specifically to recent checkpoint inhibitor safety issues that emerged. My concerns include long term safety issues of using these various types of drugs including latency reactivating agents which were the paradigm of research over the past few years, as Steve Deeks referred to it at the OAR meeting, but they may have long term safety issues that remain unknown. Dan makes reference in his talk about the risk of long term safety issues that are unknown now. Finally perhaps my greatest concern is - are these risks adequately communicated to patient study participants? Do they really understand that by entering these cure studies there is no short term benefit for themselves health-wise but do they really understand the potential risks, particularly of my concern is the risk for reseeding reservoirs, and separately what are the affects in inflammation & comorbidities, and the affects of turning off & on HIV in plasma. Unfortunately its not only the media hyping the potential for cure but are advocates also hyping cure research in the sense that risks for study participation are overlooked or not adequately addressed as they try to encourage patients to enroll in these studies. Are study investigators including the ACTG not adequately communicating to potential study enrollees the risks & limitations of these early cure studies. And is the NIH providing adequate over site regarding these issues. Finally as I always do I want to mention Aging, In the broad context of importance to patients where we want to find a cure IF possible, and I agree we should continue cure research, but in a larger context Aging with HIV is real. HIV accelerates the aging process! - aging/older patients are experiencing devastating insufferable multiple comorbidities, often 4-6 at once, accompanying polypharmacy, frailty, falls & fractures, and significant cognitive & neurologic decline. In this larger context we are NOT giving adequate attention to AGING with HIV: are research efforts into finding an anti-inflammatory adequate or too narrow? What about the debilitating affects on daily living of older patients - they often cannot perform daily independent living activities without a struggle, like shopping, getting to doctor appointments. Suicidal ideation will increase, depression will increase, adherence will suffer, and survival WILL decline for these patients. Again I say we need a national Discssion, a roundtable discussion at the OAR & the NIH just like Cure is getting witnessed by these cure meetings, but this is NOT happening! In the end even if a functional cure or eradication would be found we would still have to compare its short & long term outcomes to HAART, which is really safer & more effective remains an open question, which will have to be studied in a long term study.
link to newer cure research studies:
New HIV Cure Research/Reports - (02/01/17)
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