Turning a positive into a negative

A look into the future of the HIV and AIDS epidemic, finding a solution

Alycen Dodds

A look into the future of the HIV and AIDS epidemic, finding a solution

By Assistant Sports & Health Editor Additional reporting by Brandon Smith

Seven years ago, the only thing Rashid Bashir, leading developer and head of the Department of Bioengineering at the University of Illinois at Urbana-Champaign, and his researchers needed to revolutionize HIV and AIDS testing was one drop of blood.

Bashir and his team developed a first-generation device that could be used to detect HIV and AIDS by placing a single drop of blood on a microfluidic biochip. It was modeled after the blood sugar monitors diabetics use, eliminating a process that usually requires a vial of blood and a trip to the doctor’s office. Since then, Bashir said his team has expanded the technology and developed a second-generation model that is not only used for initial diagnostics but also tracks how the patient’s immune system is responding to treatment.

Bashir said current diagnostic methods create challenges and the device could provide less costly, easy-to-use, immediate disease diagnostics, particularly in remote areas of the world where people living with HIV have limited resources.

“The goal we’re moving to is called ‘point of care’ diagnostics where you can do it yourself and very quickly, and in this case it’s not to take the patient to the lab, but to take the lab to the patient,” Bashir said. “Technology is advancing to a point now where we can develop these tests in a disposable one-time use format.”

While the device has not been released yet, the group is working to miniaturize it to a handheld size and design a cartridge that can be massproduced, Bashir said.

More than 1.1 million people in the U.S. are living with HIV, and 1 in 6 of those infected are unaware. Although the annual number of new HIV infections remains relatively stable, the number of people living with HIV has increased throughout the past decade, according to AIDS.gov.

While it is estimated that 50,000 new HIV infections occur each year in the U.S., scientists have made significant advances in medical research during the past five years in terms of diagnosis, intervention and prevention, though the public continues to be misinformed.

America’s perception of the disease is incomplete, according to a 2012 poll on America’s perception of HIV and AIDS conducted by the Washington Post and the Kaiser Family Foundation. While the overall perception regarding the progress against HIV and AIDS is considerably optimistic, there is still a disconnect because many people still have misconceptions about how the virus is transmitted.

According to the poll, roughly a quarter of Americans still believe that HIV can be transmitted by sharing a drinking glass, a view commonly held in 1987.

“There is still a lot of ignorance out there [when it comes] to understanding it and a lot of fear, and stigma becomes a big barrier then to people wanting access to care and treatment because they have to talk about their HIV status,” said Michael Kaplan, president and CEO of AIDS United.

But with more work comes more progress, Kaplan said, noting that he has seen a vast change within the last four years, citing the U.S. government’s reversal of a policy in 2012 that prohibited known HIV-positive people from entering the U.S.

Human immunodeficiency virus, or HIV, destroys the immune system, making carriers susceptible to the acquired immunodeficiency syndrome, or AIDS. HIV spreads through the body, affecting CD4 cells, or T-Cells, which are responsible for activating the body’s immune response system when viruses or bacteria are detected, thus rendering the immune system useless and leaving those infected completely vulnerable.

Because HIV is a virus that mutates often, it is very difficult to determine what factors allow HIV to progress into AIDS at the cellular level. It has two strains: HIV-1 and HIV-2. HIV-1 is the most common and leads to AIDS, while HIV-2, commonly found in West Africa, does not lead to AIDS—a discrepancy scientists have been researching for many years.

While HIV and AIDS awareness has grown since its widespread outbreak in the ‘80s and medicine has improved—at least 28 different drugs are available to manage the disease—there is still work to be done to put an end to the epidemic, both on medical and cultural fronts, Kaplan said.

“I would say there is more opportunity to end the epidemic than ever before, but the level of alertness, energy [and] action is less than it was in the ‘90s,” Kaplan said. “I am stunned when I talk to people not in the AIDS field [at] how few understand the power of where we are in this epidemic and the idea that treatment can truly work as prevention.”

In 2010, researcher Nicolas Manel and a group of colleagues at New York University found that dendritic cells—white blood cells in the immune system that trigger protective immune responses—were able to detect and work against HIV-2, preventing the strain from progressing into AIDS, but were unable to detect HIV-1 because it creates an “invisibility cloak” that shields it from detection, leaving scientists puzzled.

Manel moved his research to the Institut Curie in Paris, and with the help of fellow scientists found that HIV-1 evades detection because of its capsid, a protein shell surrounding the virus, according to Manel’s study published Nov. 21 in the journal Immunity. This discovery, he said, could help researchers develop effective vaccines against HIV-1, thus reducing the threat of AIDS.

“Our study shows for the first time exactly how immune cells sense the virus and how the virus uses one of its proteins to tune its stealthiness and infectivity,” Manel said. “We also show how to modify the virus so that it is properly recognized and leads to a beneficial immune response.”

Manel said each strain has a different capsid, and they were able to mutate the proteins and put the capsid of HIV-2 into HIV-1, making the latter strain detectable.

“Now we can think about ways to design or look for drugs that can either mimic what the virus should be doing to be detected or to actually force the virus to uncover itself,” Manel said. “Imagine a vaccine that would be able to change the virus in a way that is not infectious anymore because we know how it works at the molecular level.”

Manel’s cloaking mechanism discovery may only be a theory, but the researcher’s work is promis- ing, according to Richard D’Aquila, professor of medicine and director of the HIV Translational Research Center at Northwestern University.

“It’s a whole new slant at looking at how the virus gets around,” D’Aquila said. “Before that, the idea was that when [the] virus replicates, it destroys the immune cells that are needed for a good defense and depletes certain proteins from infected cells that normally would fight off HIV, but the idea that it could be cloaked, that’s really interesting and new.”

New technology has also enabled researchers to find effective prevention methods for those who are not HIV positive.

The Microbicide Trials Network is a National Institutes of Health/National Institute of Allergy and Infectious Diseases research network designed to advance antiretroviral discoveries from a pre-clinical setting into clinical phase trials. Antiretroviral compounds, known as microbicides, are the most common prevention method currently being used.

Microbicides have been in development since the early ‘90s. They are lab-developed molecules that can prevent HIV from transcribing its RNA into human DNA, effectively diminishing the virus’ infectious abilities.

Carl Dieffenbach, director of the division of AIDS at the NIH, said the global success of microbicidal medicine has placed it as one of the most important avenues of prevention research.

“Since 2001, we’ve gone from only 100,000 people in Sub-Saharan Africa and other underdeveloped nations being on antiretroviral drugs to almost 10 million,” Dieffenbach said. “It is largely due to the innovations developed through the microbicide Trials Network.”

A product like ImQuest BioSciences DuoGel is one example of a pre-clinical over-the-counter microbicide. Robert Buckheit Jr., ImQuest’s chief executive officer, said the company has developed a molecule called IQP-0528 that can be implemented in products such as gels or suppositories.

He said the idea behind DuoGel is to one day replace potentially harmful products like K-Y Jelly with a more comfortable, HIV-resistant lubricant.

However, finding a remedy for the disease has not always been promising. The early years of the AIDS epidemic plagued many and caused millions of American deaths.

The majority of the nation was unaware of the severity of HIV and AIDS at the start of the epidemic, and the disease was not clinically recognized until 1981. The initial cases were diagnosed among young, gay men contracting unusual infections and rare cancers that viciously attacked their immune systems. Only five years into the epidemic, approximately 95 percent of those with documented cases of AIDS had died, according to the Centers for Disease Control and Prevention.

“Meanwhile, in gay communities around the country, it started to wreak havoc and at that point in time, HIV was quite catastrophic and was just decimating a whole population of people,” said Jim Pickett, director of prevention advocacy and gay men’s health for AIDS Foundation Chicago.

A lack of medical research was not the only hurdle in the early years of the HIV and AIDS epidemic. While scientists were searching for a way to control the disease, there was also a widespread cultural stigma surrounding HIV and AIDS.

AIDS created a divide in the nation as many affected individuals were harshly discriminated against, particularly those in the gay community. To cope with his lifelong struggle to repress his sexual identity, Jeff Allen, now a board member at the National AIDS Housing Coalition, turned to heroin as an escape. In 1985, 20-year-old Allen began his first stint in a Florida rehabilitation center for drug addiction, and it was there that a new medical screening would change his life forever.

“[Testing positive] was scary, and it didn’t help with my addiction,” Allen said. “At that point in time I was like, ‘What the heck, I’m going to die anyway, I might as well enjoy myself,’ you know? So it kind of just compounded the problem.”

HIV destroyed Allen’s immune system, landing him in the hospital for weeks with Pneumocystis pneumonia, a severe form of pneumonia that often affects AIDS victims. He nearly died.

The U.S. Food and Drug Administration did not approve the first antiretroviral drug until the spring of 1987. Although zidovudine, or AZT, offered a new hope, it also caused controversy because doctors often over-prescribed the drug dosage in attempts to eliminate the virus.

“AZT is still being used today and it’s a good drug, [and] it wasn’t so much that AZT was bad, but it was because it was before we had other drugs to take in combination and before we had any alternatives when people would have side effects,” said David Pitrak, chief of infectious dis- ease and global health at the University of Chicago Medical Center.

By the late ‘90s, the FDA began testing and approving new medications to help manage the disease and better testing materials, such as the first HIV home-testing kit.

“The equation was no longer you get HIV, you get AIDS, you die,” Pickett said. “…Now it was if you find out your status, you can get into care and treatment and significantly prolong your life. People were preparing to die, and now they had to prepare to keep on living.”

Pitrak said there needs to be a greater push to encourage people to get tested. Although he said the diagnostic testing has improved significantly, many doctors are not committed to helping combat the disease early enough in the course of patients’ infections.

“The screening programs are very important and is something all doctors should be doing, but it really hasn’t become routine because some doc- tors don’t think it’s their responsibility, [and] some doctors are uncomfortable with talking about HIV to patients,” Pitrak said.

The CDC recommends anyone ages 13–54 to get tested at least once in his or her life, particularly those who have unprotected sex or have had sexual partners with the disease.

Although scientists are moving closer to finding vaccines that provide hope for a cure, the nation still has a long journey ahead, Pickett said.

“While America can take credit for the amazing leaps forward in science that we’ve had [on] the treatment and prevention front, we’re still not doing a very good job,” Pickett said. “We’re still not getting a very good grade for our own people when we have these sorts of disparities, where we have things that people cannot access, where people continue to become HIV-infected and fall through the cracks, [and] so we have a great deal of work to do.”