In a blind race to cure HIV, can Gene therapy be a deal-breaker?

HIV infection has become a global health burden, has claimed over 32 million lives so far since the very first case of AIDS was reported in 1981. According to a report put forward by the WHO, HIV prevalence was reported to be around 37.9million by the end of 2018. 

However, HIV has grown to pandemic proportions, Sub-Saharan Africa comes to be recognized as the majorly hit region. Residence of around 12% of the world’s population, HIV incidence in the region recorded is around 2/3^rd of the total HIV infected population.

Increasing HIV prevalence has led to the governments, pharma players, researchers and NGOs to undertake initiatives to cure HIV and prevent its outbreak by spreading awareness about the infection. The intense efforts, as a consequence, have helped in managing the HIV infection well, in the form of better diagnosis, therapies, social acceptance, increased awareness, and a better life.

As per a report by WHO, in 2018, approximately 62% of the adults and 54% of the children infected from HIV were on antiretroviral therapy (ART). Moreover, 82% of the pregnant women and breast-feeding mothers were receiving ART ensuring them a better life and an infection-free life to their offspring. 

However, there remain gaps to be bridged. 

Unmet Needs 

Firstly, not everyone who is infected with HIV is able to access to the care and therapies. Besides this, it is more worrying that most of the HIV infected people remain in the dark about their disease throughout. Diagnosing the HIV-positive cases is still a huge hurdle.

The Global UNAIDS 2020 90-90-90 target, which aimed to achieve 90% of the people living with HIV knowing their status, of whom 90% should be on treatment and 90% out of those should have been virally suppressed by the year 2020 ends. This super fast-track target is still way too far to see the sunlight. 

In order to achieve the aim, it is imperative to prioritize the viral-load oriented care, assessing and monitoring the status of the treatment. There is still need of eliminating the social stigma associated with the HIV infection. Additionally, ancillary support in the form of diagnostic services such as laboratory tests, radiology, genetic testing, diagnostic imaging; therapeutic services including rehabilitation to physical and occupational therapy; and custodial services such as long-term acute care will also ameliorate to the initiatives taken to achieve the targets. 

These untended gaps have resulted in the death of 770,000 people due to HIV and new HIV cases of around 1.7million say the WHO report.

Treatments approaches

As the HIV pandemic spurs, many treatment methods have been tried and tested to prevent the progression as well as the eliminate the disease once and for all. One such approach is Gene and cell therapy which has proved its worth in treating several chronic disorders such as cancer. Today, HIV-based lentiviral vectors, along with many other gene delivery strategies, have been used to evaluate HIV cure.

At present, in the Cancer treatment market homes two FDA-approved therapies to target malignancies. Similarly, to cure HIV, multiple tangents of the cell and gene therapy are under investigation. Multitude researches are undergoing evaluating CD4T cells from HIV+ patients and altering them in a way to ensure the non-transcription of HIV co-receptors CCR5. 

Modifying the immune systems cells of the patient genetically is the major deciding factor in successfully delivering the therapy and curing HIV. Often times, this results in developing the risk of rejection of transplanted cells i.e., graft versus host disease. Moreover, the affordability of gene therapy is also one of the most challenging obstacles that need to be faced.