The director of the Doherty Institute, Prof Sharon Lewin, has found that a medicine used to treat cancer can also be used to treat HIV, exposing it to the immune system and making it more susceptible to attack.
One of the barriers to finding a cure for HIV is its ability to hide in cells even in people on antiretroviral therapy.
HIV patients on drug treatments can live normal and healthy lives, but the virus is never completely eliminated from their cells.
This is because the immune system cells are in a state of hibernation. These cells need T-cells to destroy the virus. The T-cells can't find the hidden HIV because they can't detect it.
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In cancer patients, killer T-cells become malfunctioning, leading them to express exhaustion proteins on their surface. Lewin found that exhaustion markers like PD1 allow HIV to hide.
The drug Pembrolizumab blocks exhaustion markers in cancer patients, allowing the killer T-cells to regain function and fight the cancer. The anti-PD1 drug has made a difference in the treatment of cancer.
There is a barrier to testing the treatment for HIV patients because of the side-effects of pembrolizumab.
The adverse event from pembrolizumab is not a major concern for people with a life-threatening illness. People with HIV can live normal and healthy lives, so any intervention for a cure must have low toxicity.
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Lewin and her team were able to test pembrolizumab against HIV in 32 people who also have cancer. The drug had anti-PD1 properties. The journal Science Translational Medicine published their discovery.
The effect of anti-PD1 on people with HIV who also need the treatment for their cancer is very rare. Anti-PD1 has the potential to boost the immune response, which is something that other treatments have not been able to do.
Lewin said it was like you had a two-in-one drug.
Lewin's research shows that anti-PD1 can reverse HIV symptoms, but it's not known if it can also boost the immune system to attack and destroy HIV.
Is it possible to enhance the immune system effect further by putting anti-PD1 with other agents? Lewin said that the most important thing to examine now is how to dose anti-PD1 safely in people with HIV but who don't have cancer.
Lewin's team was known for examining latency reversing agents, according to Stuart Turville, an associate professor at the Kirby Institute.
He said that it was normal for the immune system to be resting. HIV can take advantage of this. It enters cells that rest and sits there for a long time.
In this study of cancer patients with HIV, they found that the virus was woken up by the administration of the PD1 inhibitor, using cutting-edge techniques developed to analyse the HIV reservoir at high sensitivity and at a granular level.
He believes the study shows that there is a pathway to a pragmatic HIV cure.
Lewin said that while existing treatments for HIV were safe, effective, and led to good health, it was still important to work towards a cure because treatment was lifelong and not everyone had access to it.
70% of people have access to treatment, but lifelong access is not guaranteed for everyone and is a real challenge for the world. We need a cure as well as treatment for that.
I think anti-PD1 will form part of a multi-pronged intervention. I don't think a single drug or intervention will cure HIV.
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