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SHOCK AND KILL
STOPPING THE REPLICATION OF HIV
Last year in a clinical trial scientists showed that this
approach has the potential to become a functional
cure for HIV. The key to its potential is that it can
target the reservoir of HIV viruses that “hide”
inactive within our cells. Current therapies
suppress the virus in circulation by inhibiting the
formation of new viruses, but they don't touch the
reservoir. Once you stop, the virus comes back in
10-14 days. ABX464 is the rst drug candidate
ever shown to reduce the HIV reservoir. The drug,
called ABX464, binds to a specic sequence in the
RNA of the virus, inhibiting its replication.
Another approach that is becoming popular in the ght
against HIV also goes after the hidden HIV reservoir. The
“shock and kill” or “kick and kill” approach uses latency-
reversing agents (LRAs) that activate or “kick” the latent HIV
reservoir, making it possible for standard antiretroviral
therapy to “kill” these viruses. In 2016, a group of UK
universities reported promising results from one patient
treated with this approach. A similar strategy using vaccine
is currently being tested. One stimulates the production of
antibodies that block the replication of HIV, while the other
attacks the reservoir.
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IMMUNOTHERAPY GENE THERAPY
What makes HIV so dangerous is that it attacks the
immune system, leaving people unprotected
against infections. But what if we could supercharge
immune cells to ght back? That's the reasoning
behind immunotherapies. Researchers reported
last year that thanks to an immunotherapy that
primes the immune system against the virus, 7 out
of 15 patients were cured. Their approach
combines a drug to activate the hidden HIV
reservoir with a vaccine that can induce an immune
response thousands of times stronger than usual. It is estimated that about 1% of the people in the world
are naturally immune to HIV. The reason is a genetic
mutation on the gene that encodes CCR5, a protein on
the surface of immune cells that the HIV virus uses to
enter and infect them. People with this mutation are
missing part of the CCR5 protein, making it impossible
for HIV to bind to it. Using gene therapy, it would, in
theory, be possible to edit our DNA and introduce this
mutation to stop HIV. In the future, gene therapy for HIV
could be done with CRISPR, a gene editing tool that is
much easier and faster to make. Its potential in HIV has
already been shown in vitro, and soon HIV could
become of the rst diseases to be cured with CRISPR.
DECEMBER 2018
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