AIDS: the battle of the reservoirs continues!

[20 July 2009 - 14h04]
[mis à jour le 26 August 2009 à 10h59]

With HIV – as with all chronic diseases – the aim is to simplify treatments, reduce their secondary effects and the risks – in particular cardiovascular and hepatic problems – associated with their long-term use. This – along with solving the economic equation – is also one of the keys to providing universal access to treatment. At the International AIDS Society (IAS) Conference being held in Cape Town, discussions will return to this issue a great deal during the 3 coming days.

It is also vital to find a way of destroying the “reservoirs” – those cells of last resort to which HIV retreats when antiretrovirals have reduced it to inactivity. Today, little is known about the identity of these cells.. As Françoise Barré-Sinoussi points out, these may be specific elements of the blood – such as lymphocytes, monocytes or macrophages – that have taken refuge in systems or organs of the body that treatments have trouble reaching: the brain, the genitourinary organs, the digestive system and the central nervous system, for example.

Strategies to gain access to these reservoirs are still very uncertain. Even the most effective antiretroviral treatments have shown their limitations. Professor Jean-François Delfraissy, director of the French National AIDS Research Agency (ANRS), explains that a trial conducted “on heavily monitored patients showed that raltegravir – the first integrase inhibitor – did not result in any greater decrease in viral activity. It is a short trial, 28 weeks, but obviously it is not very encouraging”.

Other options are being explored. In Germany, one patient infected with HIV and treated for leukaemia by bone marrow transplant, was saved. But bone marrow allotransplant – from donor bone marrow – “is too unwieldy a technique and is associated with mortality in the order of 30%”, points out Professor Molina. It is therefore not a method to be adopted for general use when HIV itself is today considered to be of low vital risk. Use of immuno-modulating treatments – similar to vaccines – and of targeted chemotherapy, are also being explored.

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009-07-20

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