Each morning, Amara Jackson fills a tall glass of water and swallows a pale pink pill.
She doesn’t need to be called back. The 19-year-old student has been on antiretroviral therapy (ART) her entire life.
“I don’t even think about it,” she said. “It’s just a part of who I am.”
Jackson is one of 1.2 million Americans living with HIV. She was born with the virus; his mother was infected and transmitted it.
Every six months, Jackson sees his doctors at Emory University at Grady’s Ponce De Leon Center, which specializes in HIV and AIDS. So far, the drug is doing its job, keeping the virus at almost undetectable levels. She is in good health – in great shape, even. But the virus is still in her. And if she stops treatment, it will likely come out of hiding and attack her immune system.
One day, Jackson would like to be completely free from HIV. For a long time it seemed unthinkable. But maybe not anymore.
This year, the National Institutes of Health, through the Martin Delaney Collaboratories for HIV Cure Research, invested approximately $ 53 million in eradicating the virus. This is the highest annual amount the consortium has awarded, and funding will continue for five years.
Emory researchers lead two of the initiatives – called collaborations because they involve large networks of researchers from different institutions. One of Emory’s collaborators aims to learn more about the potential for cure or remission of HIV in children, and the other is examining immune therapies to clear or control the virus in the absence of ART. Both projects draw heavily on the animals, technology and expertise of Emory’s Yerkes National Primate Research Center, the only primate center to run a Martin Delaney lab.
“Finding a cure is always a huge challenge, but recent discoveries and advances make us optimistic,” says Mirko Paiardini, who leads the Emory study testing immune therapies for a cure for HIV.
The new funding comes as the United States celebrates the 40th anniversary of the first official report on what has become AIDS.
Over the course of these four decades, what was once a fatal disease has become, for many, a chronic disease. Anti-HIV drugs – including Emtriva and Epivir developed by Emory – are able to suppress viral loads in most people infected with the virus, but the virus has an exasperating ability to hide inside the body in spaces. areas called reservoirs and rebound when patients stop taking their medications.
Prevention efforts, such as pre-exposure prophylaxis (PrEP), have helped reduce new infections Yet every day more than 4,000 people around the world are newly infected with HIV. Efforts to find a vaccine have so far been unsuccessful.
But a new understanding of how the virus works is focusing new attention on finding a cure.
For proof, it suffices to follow the financing. Ten years ago, 90% of Emory’s HIV research funding was for vaccine work and only 10% was for work that could lead to treatment. Today that number is roughly evenly distributed.
Work on an HIV vaccine is important, but it does not help the millions of people already infected, including many children, like Jackson, who were born with the virus.
Hope for HIV positive children
Ann Chahroudi is Co-Principal Investigator of the Pediatric HIV Study. The $ 27.6 million five-year Pediatric Adolescent Virus Elimination (PAVE) Collaborative involves 36 US-based and overseas co-investigators.
“We know that children’s immune systems are different,” says Chahroudi. “But there is still a lot we don’t know about HIV and children, especially infants. “
HIV can be transmitted from mother to child through the placenta, during childbirth or even through breast milk.. A central question PAVE seeks to answer is whether an infant’s unique immune system might be tricked into preventing HIV from taking root in the first place. PAVE will also develop procedures, tools and techniques, including imaging, to monitor HIV and specific immune responses in infants, children and adolescents.
The co-principal investigator of the PAVE collaboration is Deborah Persaud, MD, virologist and professor at Johns Hopkins University School of Medicine, who worked with the “baby from Mississippi”.
Born prematurely to a woman who was unaware she was HIV-positive and therefore had not received any treatment during pregnancy, the infant began an aggressive regimen of liquid antiretroviral drugs the day after birth and continued until she was born. 18 months old. She was drug-free and virus-free for the next 27 months. But then, just two months before her fourth birthday, the virus reappeared, dashing hopes for a medical breakthrough.
“It was disappointing, but we also learned from it,” says Chahroudi. “Her story has prompted scientists around the world to start thinking more deeply about HIV remission strategies for children. “
For Jackson, who has spent his life battling HIV, the prospect of a cure is tantalizing.
“It would be really amazing, because I feel like it would help a lot of people,” she says. “I’ve had doctors and good treatment, but not everyone has that.”
It takes a community
In 1989, when the number of AIDS cases in the United States exceeded 100,000, Dazon Dixon Diallo stepped in to help women in need.
She remembers the early days of AIDS.
Stigma. The fear. The despair.
“It was a death sentence,” she says. “The prognosis was sometimes only a few weeks. People would just disappear.
Based in Atlanta, she has seen infections soar at an alarming rate. Most of the emphasis was on gay men. But HIV was also wreaking havoc on people of color, including women. And they were largely ignored.
Seeking to help those affected and prevent AIDS from recording more cases, Diallo started SisterLove. It was the first HIV, sexual and reproductive justice organization in the Southeastern United States to focus on women.
Three decades later, SisterLove is still going strong and Diallo’s core work has given women better access to HIV treatment and clinical trials.
When Emory researchers asked if SisterLove would partner with The Enterprise for Research and Advocacy to Stop and Eradicate HIV (ERASE HIV), Diallo jumped at the chance. She fought for a long time to make community engagement a starting point for major research projects, rather than being added after the fact.
“One thing we are seeing with COVID is that a scientific discovery, like a vaccine, is only effective if people benefit from it,” says Diallo. “If you’re engaged from the start – educating the wider community about what’s going on and developing health literacy – then you’re more likely to have confidence and buy-in. “
“Shock and kill”
Paiardini leads ERASE HIV, a five-year, $ 23.8 million project, with fellow researchers Emory Deanna Kulpa and Guido Silvestri. This partnership will accelerate research to cure HIV infection or eliminate latent HIV after stopping ART, essentially putting HIV in permanent remission.
There are reasons to be optimistic about a future free from HIV / AIDS.
Emory has been a leader in harnessing the immune system to promote its ability to control and eliminate the viral reservoir. One example is the so-called “shock and kill”. The idea is to wake up latent viruses and then chase them from their hiding places where they can then be killed. The “shock” part of the theory has shown promise in mice and monkeys.
Another example is a strategy to improve immune responses to intercept virus that tries to rebound immediately after stopping ART.
SisterLove forms an advisory committee to work with the ERASE HIV team. Information will flow in two ways: researchers will share their scientific studies and advances with the community, and the community will share first-hand information about living with HIV with researchers.
“Without this kind of involvement, this research will remain in the academic silo and will not be accessible to community members who are affected,” says Indya Hairston, SisterLove’s community program manager on the ERASE HIV project.
“From bench to body, this is the way to go,” she said. “When science engages with the community, everyone wins. “