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HIV cure and eradication Rationales and Options  Pana Tanjararak, MD
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Why do we need a cure for HIV? ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],Why do we need a cure for HIV? Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Functional or sterilizing cure ,[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sterilizing cure: Elimination of HIV following BMT ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sterilizing cure: Elimination of HIV following BMT Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Sterilizing cure: Elimination of HIV following BMT Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sterilizing cure: Elimination of HIV following BMT ,[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],Sterilizing cure: Elimination of HIV following BMT Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Functional cure: elite controllers (EC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Functional cure: elite controllers (EC) ,[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Functional cure: elite controllers (EC) Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Measuring latently infected cells and the ‘‘reservoir’’ in vivo ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Measuring latently infected cells and the ‘‘reservoir’’ in vivo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Measuring latently infected cells and the ‘‘reservoir’’ in vivo Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Replication competent virus – cell associated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV-DNA – unintegrated, integrated and circular ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV-DNA – unintegrated, integrated and circular ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV-DNA – unintegrated, integrated and circular ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV-DNA – unintegrated, integrated and circular ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],HIV-DNA – unintegrated, integrated and circular Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV RNA - plasma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV RNA - plasma ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV RNA – cell associated ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV RNA – cell associated ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV RNA – cell associated ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Blood or tissue? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Blood or tissue? ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Current and future strategies: advantages, disadvantages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Current and future strategies: advantages, disadvantages Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Current and future strategies: advantages, disadvantages ,[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Current and future strategies: advantages, disadvantages ,[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Current and future strategies: advantages, disadvantages ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Boosting immunity to HIV: therapeutic vaccination ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],Boosting immunity to HIV: therapeutic vaccination Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],Boosting immunity to HIV: therapeutic vaccination Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Making cells resistant to HIV ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Making cells resistant to HIV ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Making cells resistant to HIV ,[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Making cells resistant to HIV ,[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Moving toward clinical trials to test for eradication ,[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],Moving toward clinical trials to test for eradication Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],[object Object],Moving toward clinical trials to test for eradication Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Clinical trial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Clinical trial ,[object Object],[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
[object Object],[object Object],Clinical trial Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
Conclusion ,[object Object],[object Object],[object Object],[object Object],Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia.  Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
HIV Cure and Eradication   Chemokine Receptor 5 Knockout Strategies Using  Zinc-finger Nuclease Rongpong Plongla, MD
[object Object],[object Object],[object Object],Marvin S Reitz Jr., and Robert C Gallo. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. 2009
The Life Cycle of Human Immunodeficiency Virus Type 1 Marvin S Reitz Jr and Robert C Gallo. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. 2009 Joan stephenson. JAMA. 2002;287(13):1635-1637 .
Mechanism of HIV entry Jose’   A Este’ ,  Amalio Telenti. Lancet 2007; 370: 81–88  Retrovirology Laboratory IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autnoma deBarcelona, Badalona, Spain (J A Este PhD) and Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland (A Telenti MD)
[object Object],[object Object],[object Object],[object Object],[object Object],James O. Kahn, M.D., and Bruce D. Walker, M.D. N Engl J Med 1998; 339:33-39 From the AIDS Program, San Francisco General Hospital and the University of California, San Francisco (J.O.K.), and Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (B.D.W.) ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Jose’   A Este’ ,  Amalio Telenti. Lancet 2007; 370: 81–88  Retrovirology Laboratory IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autnoma deBarcelona, Badalona, Spain (J A Este PhD) and Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland (A Telenti MD)
HIV Tropism and Disease Progression Kuhmann SE, et al. J Viral Entry. 2005;1:4-16. Moore JP, et al. AIDS Res Hum Retroviruses. 2004;20:111-126. Time Since Seroconversion HIV-1 RNA Level Current assays’ X4 detection limit Weeks Years R5 virus X4 virus R5 Infection R5 + X4 Infection
Jose’   A Este’ ,  Amalio Telenti. Lancet 2007; 370: 81–88  Retrovirology Laboratory IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autnoma deBarcelona, Badalona, Spain (J A Este PhD) and Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland (A Telenti MD) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CCR5 Wild Type and CCR5   32 CCR5 wild type       CCR5   32  2 normal copies 1 copy of   32 2 copies of   32 wt/wt wt/  32  32 /  32 Standard disease progression Delayed disease progression “ Resistant” to HIV infection Normal Heterozygous Homozygous Liu R, et al. Cell. 1996;86:367-367. Samson M, et al. Nature. 1996;382:722-725. Dean M, et al. Science. 1996;273:1856-1862. Huang Y, et al. Nat Med.1996;2:1240-1243. Michael NL, et al. Nat Med. 1997;3:1160-1162. Eugen-Olsen J, et al. AIDS. 1997;11:305-310.
Patients Homozygous or Heterozygous for CCR5   32 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. McNicholl JM, et al. Emerg Infect Dis. 1997;3:261-271. 2.  Liu R, et al. Cell. 1996;86:367-367. 3. Samson M, et al. Nature. 1996;382:722-725.  4. Wu L, et al. J Exp Med. 1997;185:1681-1691.
 
< 6hr 1 day ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],14 day
J  Allergy Clin Immunol 2008; 122: 22-8 •  Latently infected  resting memory CD4+ T  cells are the best characterized latent reservoir for HIV-1. •  Less than 1 cell per 1,000,000 resting CD4+ T cells from patients on HAART harbor latent HIV-1 provirus. •  Sequence of latent proviruses does not evolve, which suggests no ongoing viral replication. •  Discontinuation of HAART allows viral relapse from latent reservoir. •  Patients successfully treated with HAART for longer than 10 years exhibit no appreciable decrease in the size of the latent reservoir. •  The persistence of latently infected memory CD4+ T lymphocytes precludes their elimination by HAART alone for the lifetime of the patient. •  Other drug-insensitive reservoirs, including brain, macrophages, and hematopoietic stem cells, may also exist. •  Latency is likely established and maintained by numerous blocks at multiple steps in the HIV-1 replicative pathway, which potentially complicates eradication strategies. Douglas D. Richman.* David M. Margolis, Martin Delaney, Warner C. Greene,  Daria Hazuda, Roger J. Pomerantz.   Science 6 March 2009:  Vol. 323 no. 5919 pp. 1304-1307 .  University of California San Diego
Can We Do Better Than HAART?
 
The Berlin Patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2009;360:692-8.
allogeneic stem-cell transplantation with CD34+ peripheral-blood stem cells from an HLA-identical donor who had been screened for homozygosity for the  CCR5 delta32 allele. ,[object Object],[object Object],N Engl J Med 2009;360:692-8. Cobas AmpliPrep–TaqMan HIV assay system (Roche).
[object Object],N Engl J Med 2009;360:692-8. + - D14 D625 Immunosuppressive treatment has been stopped 38 months
[object Object],Blood 2011; 117: 2791-99. effector memory cells (EM), central memory cells (CM), recent thymic emigrants (RTE), and central naïve cells (CN)
[object Object],[object Object],[object Object],[object Object],[object Object],Blood 2011; 117: 2791-99.
Paula Cannon, CROI2011
CCR5 knockout strategies ,[object Object],[object Object],[object Object],[object Object],[object Object],Holt N, etal. Nat Biotechnol. 2010 Aug;28(8):839-47.
An alternative approach: the use of engineered ZFNs to permanently disrupt the  CCR5  open reading frame .  ,[object Object],[object Object],Holt N, etal. Nat Biotechnol. 2010 Aug;28(8):839-47.
ZFNs: designer restriction enzymes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Paula Cannon and Carl June. Current Opinion in HIV and AIDS 2011; 6: 74-79. Molecular Microbiology & Immunology, University ofSouthern California Keck School of Medicine, Los Angeles, California and Department of Pathology andLaboratory Medicine, University of PennsylvaniaSchool of Medicine, Philadelphia, Pennsylvania, USA Flavobacterium  okeanokoites
Flavobacterium  okeanokoites
Double-strand break
Fyodor D. Urnov 1 , Edward J. Rebar 1 , Michael C. Holmes 1 , H. Steve Zhang 1  & Philip D. Gregory Nature Reviews Genetics 11, 636-646 (September 2010)
Paula Cannon and Carl June. Current Opinion in HIV and AIDS 2011; 6: 74-79. Molecular Microbiology & Immunology, University ofSouthern California Keck School of Medicine, Los Angeles, California and Department of Pathology andLaboratory Medicine, University of PennsylvaniaSchool of Medicine, Philadelphia, Pennsylvania, USA
Paula Cannon, CROI2011
Pre-clinical testing using humanized mice
[object Object],[object Object],[object Object],Nat Biotechnol. 2010 Aug;28(8):839-47.
Nat Biotechnol. 2010 Aug;28(8):839-47.
Nat Biotechnol. 2010 Aug;28(8):839-47.
Paula Cannon, CROI2011
 
 
 
 
Paula Cannon, CROI2011
 
 
Paula Cannon and Carl June. Current Opinion in HIV and AIDS 2011; 6: 74-79. Molecular Microbiology & Immunology, University ofSouthern California Keck School of Medicine, Los Angeles, California and Department of Pathology andLaboratory Medicine, University of PennsylvaniaSchool of Medicine, Philadelphia, Pennsylvania, USA
Clinical Trials
SB-728
 
 
 
 
 
 
Nat Biotech 2008
Nat Biotech 2008 25% CCR5 modification
 
 
About 50% of the human population has antibodies !
 
 
 
6%, 3%, 1%, 2% and 2% at 14 days
 
 
 
 
 
 
Fever, Fatigue
 
Treatment interruption
 
 
4%
 
 
 
 
 
 
 
 
 
 
 
 
[object Object],[object Object],BMJ 2011; 342:d1373
many questions remain unanswered: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You

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Topic review HIV eradication

  • 1. HIV cure and eradication Rationales and Options Pana Tanjararak, MD
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  • 19. Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia. Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
  • 20. Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia. Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
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  • 42. Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia. Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
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  • 60. Sharon R Lewin and Christine Rouzioux. AIDS 2011; 25: 000-000. Infectious diseases unit, The Alfred, Monash University Melbourne, Australia. Laboratory of virology, Hopital Necker, Universite Paris Descartes, Paris, France.
  • 61.
  • 62. HIV Cure and Eradication Chemokine Receptor 5 Knockout Strategies Using Zinc-finger Nuclease Rongpong Plongla, MD
  • 63.
  • 64. The Life Cycle of Human Immunodeficiency Virus Type 1 Marvin S Reitz Jr and Robert C Gallo. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. 2009 Joan stephenson. JAMA. 2002;287(13):1635-1637 .
  • 65. Mechanism of HIV entry Jose’ A Este’ , Amalio Telenti. Lancet 2007; 370: 81–88 Retrovirology Laboratory IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autnoma deBarcelona, Badalona, Spain (J A Este PhD) and Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland (A Telenti MD)
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  • 68. HIV Tropism and Disease Progression Kuhmann SE, et al. J Viral Entry. 2005;1:4-16. Moore JP, et al. AIDS Res Hum Retroviruses. 2004;20:111-126. Time Since Seroconversion HIV-1 RNA Level Current assays’ X4 detection limit Weeks Years R5 virus X4 virus R5 Infection R5 + X4 Infection
  • 69.
  • 70. CCR5 Wild Type and CCR5  32 CCR5 wild type   CCR5  32 2 normal copies 1 copy of  32 2 copies of  32 wt/wt wt/  32  32 /  32 Standard disease progression Delayed disease progression “ Resistant” to HIV infection Normal Heterozygous Homozygous Liu R, et al. Cell. 1996;86:367-367. Samson M, et al. Nature. 1996;382:722-725. Dean M, et al. Science. 1996;273:1856-1862. Huang Y, et al. Nat Med.1996;2:1240-1243. Michael NL, et al. Nat Med. 1997;3:1160-1162. Eugen-Olsen J, et al. AIDS. 1997;11:305-310.
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  • 72.  
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  • 74. J Allergy Clin Immunol 2008; 122: 22-8 • Latently infected resting memory CD4+ T cells are the best characterized latent reservoir for HIV-1. • Less than 1 cell per 1,000,000 resting CD4+ T cells from patients on HAART harbor latent HIV-1 provirus. • Sequence of latent proviruses does not evolve, which suggests no ongoing viral replication. • Discontinuation of HAART allows viral relapse from latent reservoir. • Patients successfully treated with HAART for longer than 10 years exhibit no appreciable decrease in the size of the latent reservoir. • The persistence of latently infected memory CD4+ T lymphocytes precludes their elimination by HAART alone for the lifetime of the patient. • Other drug-insensitive reservoirs, including brain, macrophages, and hematopoietic stem cells, may also exist. • Latency is likely established and maintained by numerous blocks at multiple steps in the HIV-1 replicative pathway, which potentially complicates eradication strategies. Douglas D. Richman.* David M. Margolis, Martin Delaney, Warner C. Greene, Daria Hazuda, Roger J. Pomerantz. Science 6 March 2009: Vol. 323 no. 5919 pp. 1304-1307 . University of California San Diego
  • 75. Can We Do Better Than HAART?
  • 76.  
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