Friday, February 11, 2011

Plenty of work ahead, but HIV becomes a model for research

Paul Volberding is an optimist who has every reason to be a pessimist.
On his first day as chief of oncology at San Francisco General Hospital in July 1981, Volberding was directed to a patient who had been admitted a few days earlier with purple lesions diagnosed as Kaposi’s sarcoma.
“There’s the next great disease waiting for you,” a cancer specialist told Volberding, according to the book “And the Band Played On.”

The other stories in our package of how the Bay Area continues to tackle HIV:

The deadly, crafty virus at the core of the worldwide AIDS epidemic could meet its match in the Bay Area.
Thirty years after AIDS was first described — and 24 years since the first potent drug therapy tackled human immunodeficiency virus and extended the lives of HIV patients by decades — scientists are using drugs to prevent AIDS and honing in on ways to eradicate the disease from the body altogether.
Research led by the J. David Gladstone Institutes in San Francisco, for example — using an established HIV-fighting drug developed by Gilead Sciences Inc. of Foster City — could translate this year into a preventative treatment for male sexual partners of men infected with HIV.

Don Francis has tracked HIV since the early 1980s, after helping eradicate smallpox in Sudan, India and Bangladesh, doing early work on the hepatitis B vaccine and studying the Ebola virus.
While working at the federal Centers for Disease Control, Francis suggested early in the AIDS epidemic that the disease is caused by an infectious agent.
Today, Francis remains outspoken in his belief that an HIV vaccine — the holy grail of AIDS treatment — is within reach, if only the National Institutes of Health would support his effort with cash.

People are living longer with HIV, thanks to antiretroviral drugs that largely tame the deadly virus, but they appear to be dying a decade or more earlier from neurodegenerative, cardiovascular and other health problems than those who are not infected.

Gilead Sciences Inc. isn’t slowing down.
While other companies have exited HIV, where 26 powerful antiretroviral drugs now crowd the market, the Foster City-based company continues to push on with new drugs, boosters and easier-to-use combinations and formulations. That eventually could lead to once-a-month pills.
Sales from Gilead’s antiretroviral franchise, led by the three-in-one pill Atripla, have grown 177 percent in the past five years to more than $6.5 billion. Those drugs account for 82 percent of Gilead’s total revenue.
Yet Gilead also is pushing its drug into the developing world, sacrificing revenue in the process. Researchers have used one of its drugs, Viread or tenofovir, in a landmark South African study of a vaginal gel. Gilead donated 65 pounds of the drug.

Mike McCune and Warner Greene are hunting a hibernating virus.
Whether in the gut, the brain, the testes or elsewhere, finding the reservoirs where latent HIV hides could hold the key to effectively eradicating it, say researchers like McCune, chief of the division of experimental medicine at the University of California, San Francisco. If those silent, HIV-infected white blood cells can be found, a drug might block the ability of the cell to survive and, as a result, dry up the reservoir.
Or, as Greene and Eric Verdin at the UCSF-affiliated J. David Gladstone Institutes theorize, the sleeping virus could be awakened, drawn out of its host cells, which normally initiate the body’s response to invading viruses, and essentially neutralized with a drug.

Eradicating the AIDS virus is no longer the stuff of dreams, researchers say. All scientists must do is hunt down the latent virus and find a way of killing HIV before it spreads or is transmitted — the next-best thing to an AIDS vaccine.
That, however, is no simple task.

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