Using a Kick and Kill Approach to Healing HIV

The first results of the first randomized clinical trial devoted to the evaluation of an experimental "kick and kill" approach to eradicate dormant HIV in the body have been reported by researchers at the annual meeting of the International AIDS Society in Amsterdam, the Netherlands. 2018).

Although the trial, referred to as the RIVER study, found no difference in the effect between those who received the "kick and kill" therapy and those who received treatment Antiretroviral Standard (ART), the researchers point out that the "kick and kill" approach opens the door to the exploration of different therapeutic combinations to combat the dormant reservoirs of HIV and demonstrates the importance of looking at outside current therapeutic approaches in the quest for a cure.

The Randomized Phase 2 Trial, conducted by researchers from Imperial College London, Oxford University, the Medical Research Council Clinical Trials Unit of University College London and the University of London. The University of Cambridge evaluated the "kick and kill" approach in a total of 60 men who had recently been diagnosed with HIV and who were subject to viral suppression under ART. The trial lasted 3 years, from 2015 to 2018, in London and Brighton

People on antiretroviral therapy are able to suppress the virus and have undetectable levels of HIV in the blood by following their treatment regimen. It also makes these individuals badually non-infectious. However, viral suppression does not equate to a cure; If an individual stops taking antiretroviral therapy, HIV sleeping in the tanks can reactivate and cause active infection once more. This knowledge has led researchers to hypothesize that a potential cure for HIV could be to kill HIV hidden in these reservoirs.

"For those who have access to it, ART brings incredible success in HIV management. Sarah Fidler, PhD, MBBS, FRCP, professor at Imperial College London, said in a recent statement. "We need to think of other sustainable alternatives and a cure or at least a form of remission. is a key goal. "

Enter the" kick and kill "strategy

For the RIVER trial, investigators used 2 therapies in addition to standard ART: vorinostat, a drug typically used to manage the cancer, which would "wake up" the reservoir cells (CD4 T cells) by expelling HIV from its hiding place to face the immune system, and 2 vaccines … ChAdV63.HIVconsv and MVA.HIVconsv – that would help the immune system not only to recognize HIV, but also to eliminate it.

The purpose of the trial was to subject those who received the "kick and kill" treatment approach to a reduction in viral levels. in CD4 T cells, but when the results are first published in April 2018, the investigators found that those who received the "kick and kill" approach in addition to ART had comparable rates of CD4 T-cell infection compared with standard antiretrovirals. 19659002] "In the RIVER study, we found that all separate parts of the kick and kill approach worked as expected and were safe," explained Dr. Fidler. "The vaccine has been working on the immune system, the basic drug has behaved as we expected, and the ART has been working to remove the viral load in the body, but the 39 study showed that this set of treatments did not represent Because of their findings, investigators were not able to recommend participants to receive the drugs "kick and kill" in addition to antiretroviral therapy; In addition, it was not proven that any of the study participants could safely stop antiretroviral therapy.

"We need to think about why we do not have antiretroviral therapy. have not found any effect, "co-principal investigator and scientific lead of the study." Frater, professor at the University of Oxford, pointed out. "The important thing to realize is that despite these disappointing results, this does not mean that the app's base rock is false. "He added that the question might have been lying in the combination of drugs used, that vorinostat may not have been powerful enough to wake up as much virus as possible for the immune system to recognize.

As such, providing more boosts of this vaccination with a different "kick" drug can be explored in further research or by evaluating the "next". According to investigators, the production of vaccines used in the study, which are currently being evaluated in other trials, also deserves to be explored further.