AIDS may be able to win in the next five years. Perspectives Medicines against HIV New drugs against HIV

Much attention is paid to the development of a preventive vaccine, the purpose of which is to protect from the VIOL-negative virus. Work on the preventive vaccine is undergoing more than a quarter of a century and is unconditional priority

To date, the main direction of research in the field of HIV treatment remains the development of new, increasingly effective antihorerular drugs. Although anti-archer therapy exceptionally successfully stops the reproduction of the virus in the body and prevents the development of AIDS, long-term treatment is associated with enormous financial costs. Recently, many countries have problems with state financing of programs for the treatment of people with HIV. It is not only about the countries of Asia and Africa with a multimillion-dollar HIV-positive population, but even about such rich states as the United States, where with the growth of budget deficit, and queues for free therapy have increased.

In addition, data appear that even despite the suppression of breeding the virus, people with HIV may experience a variety of health problems. Some of them can be caused by the side effects of drugs, others are directly related to the action of HIV. There is a point of view that even a minor presence of HIV proteins is not leading to infection of new cells - can adversely affect the immune system and cause inflammation.

Much attention is paid to the development of a preventive vaccine, the purpose of which is to protect from the VIOL-negative virus. Work on the preventive vaccine is underway for more than a quarter of a century and is an unconditional priority. Nevertheless, the creation of an effective vaccine is still submitted to the work of the future. Especially serious disappointment was the failure of large-scale clinical trials in 2007.

More experts come to the conclusion that it is necessary to revise the approach to treatment, and raises the question of finding a means of full healing of HIV infection. Under full cure means a means that will finally destroy or block the virus in the body of people with HIV. Find such a means - the cherished dream of many scientists. But what if the dream remains a dream?

When in the mid-1990s, for the first time, it was possible to achieve a stable reduction in viral load to an undetected level, many hoped that anti-rapid therapy would be able to completely defeat HIV over some time. Alas, it soon turned out that with the cessation of drug reception, the viral load soon begins to grow. The cause of the virus stability is in its ability to hide in "sleeping" cells, so-called latent tanks.

The fact is that antichriferous drugs can affect HIV only in the process of reproduction. However, the virus penetrates into different types of human cells. In some of them, he is able to maintain its genetic information for a long time. These viral tanks do not show themselves - remain latent - until time. Under certain conditions, the virus leaves the shelter and begins to affect new cells.

And yet the creation of a "final tablet" is not an empty fantasy. There is reason to believe that at least one person managed to cure from HIV infection. This is a HIV-positive American, which suffered a bone marrow transplant, the testimony for which an oncological disease was leukemia. Since the operation was carried out in Germany, the case became known in the press as "Berlin patient". In the course of treatment, the patient's immune system affected by cancer is completely destroyed and replaced by a new, developing from donor cells. In this case, the doctor used a donor material in which the CCR5 receptor gene was "turned off" by a successful coincidence that the immunodeficiency virus uses for penetration into the cell. After a transplant, three years have passed, and the "Berlin patient" is still an indefinite viral load, although it does not accept antiviral therapy all this time.

Bone marrow transplant is an expensive and dangerous operation, for such a desperate step, doctors go only with severe diseases, directly threatening the patient's life, for example, when cancer. The high risk eliminates the possibility of mass application of bone marrow transplant for the treatment of HIV infection. Nevertheless, the case of "Berlin patient" has a tremendous value for the search for the method to finally defeat HIV.

Scientists are not sure that in the body of the "Berlin patient" there was no HIV at all. Most likely, some amount of virus persists in latent tanks, but the body as a whole has become immune to the virus. If it is not possible to completely remove HIV from the body, a "functional cure" may become a compromise solution, in which the immune system will acquire the ability to suppress HIV. It is known that a small percentage of people with HIV - so-called "elite controllers" - the viral load remains low without any medication.

The main directions of studies are three. This is a preventive vaccine, the activation of the virus in latent tanks and gene therapy. Let us dwell on each details.

To suppress the viral load in people with HIV may be a useful variety of preventive vaccine. About a vaccine that will be used not to prevent the transmission of the virus, and for treatment, they speak as a therapeutic vaccine. Some candidate vaccines have been tested in the checkers of HIV-positive volunteers, but scientists have yet managed to achieve a short-term reduction in viral load.

Another possible solution is to activate the virus in latent tanks, how to wake sleeping cells. This method is supposed to be used in conjunction with traditional antiorrhivius drugs, and the probability of success may be higher at the highest early therapy (until the virus hid in a large number of latent tanks). It is expected that the only activated cells affected by HIV will become easy prey for special preparations or cells of the immune system. This approach is most logical, and a number of drugs with such a mechanism have been tested in humans. Although to the practical implementation of the method is far far, a number of concrete results have already been reached during the studies.

A promising direction is the genetic therapy. In simplified form, this approach can be described as a repetition of the effect of bone marrow transplant ("Berlin Patient") without the most risky transplant. The task is to make the human body immune to HIV, having deprived the virus of the possibility of using CCR5 for penetration into the cell. This goal is trying to achieve in different ways. For example, in the South California University, it was possible in the experiment on mice to influence stem cells in such a way that now they produce CD4 cells without CCR5 (imagine a lot of "Berlin patients", only small and fluffy). Other variants of the method are based on the transplant of modified cells or on the impact on CD4 cells using a specially created virus.

The main obstacle to scientists is, of course, the lack of finasing. The point is not in the notorious "plot of pharmaceuticals." Oddly enough, the full victory for HIV will be more profitable for pharmaceutical giants than the production of drugs for permanent reception. Although the number of potential consumers of antichriferous drugs, unfortunately, continues to grow, manufacturers are forced to constantly reduce prices under pressure from international organizations and national governments. At the same time, to the threat of the occurrence of resistance to existing drugs, it is possible to oppose only the development of new, and this is a very expensive process. Thus, if the cardinal breakthrough in the treatment of HIV infection does not occur, the development of new anti-arresting agents can be unprofitable. In addition, pharmaceutical companies do not rule the world of undivided - governments of countries with significant HIV-positive populations and insurance companies have blood interested in the fact that the means of full HIV cure was finally found.

First of all, the deficit of financing is due to the fact that colossal funds are needed on research, and no one can guarantee success. On the contrary, it is almost confident that in each individual case, the result of huge investments will most likely "also result", that is, negative.

Nevertheless, the situation is not reliable. State structures and pharmaceutical companies are more serious about finding full cure. Considerable attention to the issue of full cure HIV infection was paid to the opening of the International Conference on AIDS, held in 2010 in Vienna. Financing begins to grow. Optimists are increasingly distributed, convinced that the victory over HIV becomes closer every day.

Guys Plus, based on The Body and Poz.com

With the support of the project Lasky

December 1 - World AIDS Day. In the mid-1980s, this diagnosis was a sentence, and today the life of HIV-infected people is practically no different from the life of healthy people, we will tell about the price of such success.

Humanity learned about HIV in 1981. At first it was a mysterious ailment that kills his victims over several years, but gradually scientists began to understand the nature of the disease and create medicines that prevent the virus to multiply and infect new cells.

Small and cunning

The genome of one of the main enemies of mankind consists of all of the nine genes, which absolutely does not prevent the virus effectively infect cells and multiply. A day in the blood of a HIV-infected person is formed 10 billion new viral particles, and many of them are not similar to their "parents" due to the variability of the virus.

The virus enters the body through biological fluids - blood, sperm and even breast milk. The particles infect the cells of the immune system, carrying special receptors on their surface, to which the virus is attached before penetrating inside. Cells without these receptors HIV are not interesting.

What is AIDS

Once inside the cell, the virus immediately "turns out", that is, embeds its genetic material into cellular DNA. After that, all descendants of the infected cell will contain instructions for assembling virus particles. This cunning trick greatly complicates the lives of scientists and doctors who are looking for medicine against HIV. Even if you destroy all viral particles in the body, after some time they will reverse from healthy cells carrying viral genes.

Over time, the virus finally destroys the immune system, and HIV-infected patients die from diseases with which the body of healthy people copes relior. The state when a HIV-positive person is manifested by all sorts of infections, called AIDS.

Hypothesis

"Patient Zero"

It is believed that the human immunodeficiency virus appeared in Africa, mutating from monkey varieties of the disease. Locals are often eating chimpanzees and other primates, in addition, viral particles could get into the blood of people through bites. However, the first AIDS patients were described in the United States, from where the virus quickly spread throughout the world. To understand how HIV moved across the ocean, scientists made a map of contacts of sick people.

It turned out that most of them are homosexuals, and, having traced the history of their connections, specialists came to a person named Gaethhan Dugas - in the 1984 scientific publication, where the origin of the virus was explained, he appeared as a "patient zero". Dugas was gay, he worked as a steward and was distinguished by great lovingness: according to his own estimates, in all her life he had about 2,500 sexual relations. Most likely, the young man infected HIV from one of his lovers in Africa, where he often had, and then transferred the virus to partners from the United States. "Patient Zero" died at 31 years from the kidney defeat, which developed against the background of the decline in immunity. At the dawn of the HIV epidemic, many believed that the source of the disease is homosexual men. The story of Dugas has strengthened this faith, but very soon it turned out that any person may become infected with a virus regardless of sexual orientation.

In the hypothesis that the terrible disease spread over the planet one person, not all specialists believe, but neither one of the alternative versions also has absolutely reliable evidence.

Do not multiply

Scientists were able to "catch" the human immunodeficiency virus in 1983 - immediately two research groups allocated viral particles from samples of patients. In 1985, the first test was created, which made it possible to determine if HIV is infected with HIV.

But there was still no treatment from terrible disease. By 1987, the number of HIV-infected worldwide has reached, according to various estimates, from 100 to 150 thousand people. The authorities have long silent about the beginning of the new epidemic, but further to hide the scale of the disaster was impossible. Six years after the death of the first patients, the American president Ronald Reagan pronounced the words of HIV and AIDS in public speech. And in the same year the first medicine appeared.

First medicine

Zidovudine's drug molecule is very similar to one of the four "bricks", which are necessary for the construction of DNA. The virus synthesizes the DNA molecules to integrate them in the host cell genome, and when Zidovudine appears instead of the right "brick", the chain breaks down.

Unfolded virus genes cannot be built into the cellular gene, which means that the virus will not multiply in this cell. A enzyme that synthesizes viral DNA is called reverse transcriptase. And Zidovudine, and similar to it preparations relate to its inhibitors, that is, substances blocking the work of the enzyme.

But the joy of scientists and patients lasted for long - pretty quickly it turned out that, although Zidovudine and works, the prognosis for patients remains disappointing. In addition, the drug had serious side effects, especially since at first the medicine was used in very high doses.

Combined therapy

In 1992, the second drug against HIV appeared - Salzitabine, which could be used instead of Zidovudine or with him. Despite the fact that both drugs act similarly, their combination gave a much better effect than the use of each drug separately. Today, all Protocols for treating HIV necessarily include several substances, such an approach is called combined therapy. Different drugs block several necessary processes necessary for reproduction, and as a result, it is often possible to hold HIV in the "sleeping" state for years.

Caution, children

The HIV Anti-HIV history would be less dramatic if she concerned only adults. But the cunning virus is very well transmitted to children - on average, every third baby born from HIV-positive mother turned out to be infected. In the children's body, the virus is often more active, and without adequate treatment, kids die over several years.

Length is important

The next breakthrough occurred in 1996, when the researchers learned to "turn off" another viral enzyme - protease. HIV synthesizes part of its proteins doubled, and only then cuts a long chain to pieces, the protease is just responsible for this process. In combination with already created drugs, new drugs worked as well that some optimists spoke about the victory over HIV. But very soon it turned out that it was too early to relax, and the virus disappeared like again makes itself felt, reborn from infected cells.

Healthy generation

At the end of 1996, during clinical trials, doctors found out that Zidovudine reduces the likelihood of transmitting a virus during a childbirth to stunning 3-4 percent. Since then, even if the mother learns about his diagnosis in late pregnancy, the child has every chance to be born healthy. Moreover, in 2013, doctors managed to fully cure the girl born with HIV infection. Doctors began the therapy when the baby was 30 hours, and it seems that such an early intervention did not give the virus to "consolidate" in the body.

One tablet

Every year, scientists create new drugs for HIV treatment. In addition to the analogues of Zidovudine and various protease inhibitors, medications appeared, which do not give viral particles to attach to CD4 receptors, and substances, tightly blocking reverse transcriptase. Often, patients have to take almost a dozen tablets per day, and each in strictly defined hours, including at night.

And in 2011, a preparation appeared on the market for the first time, thanks to which people with HIV infection may not think about it round days. One tablet medication with the trade name Complera contains three different inhibitors of reverse transcriptase. In order not to give the virus to multiply, patients need to take a medicine just a day, however, always at the same time. A year later, another combined drug with other active substances appeared, so soon doctors will be able to prescribe a relaxed treatment with an increasing number of patients.

Every year the number of people infected with HIV falls. In parallel, the life expectancy of patients is growing and mortality decreases. It seems that the doctors and researchers managed to find the board in the plague of the XXI century. You can talk about the final victory after a vaccine from the immunodeficiency virus appears, and with this there are difficulties yet. But even if there are no vaccines, very soon HIV-positive people will remember their illness, only reading a medical card.

Photo: Spirit of America / Shutterstock, Shutterstock (x4)

Q. When will the vaccine from HIV infection be invented? Is there another way to cure?

O. In the next four years there will be no such an acute problem as HIV infection. Humanity will learn to cope with it.

Q. come up with a vaccine?

O. It will not be a vaccine here, but the phase of treatment that will be changed.

Q. This disease itself is? She is not fictional?

A. She is so Efemerna that talking about it as a disease is not entirely correct. This is the pattern of human development at the stage on which it is located.

Q. How to understand pattern?

O. Not a development, or rather degeneration, destruction, the moral principles were replaced. Any disease has the background, the basis. A person who leads a moral lifestyle, adheres to the basic principles, a person who is conscious has more chances to avoid this disease. Not counting cases when a person is infected in the hospital. We are talking about awareness. The conscious and morally stable person has more chances for survival. Perhaps this is the moment of cleaning and natural selection. The approach to treatment itself will be changed. There will be a vaccine, and the treatment itself will change in about 4 years.

B. From this a lot of people die. Still, is this infection, the virus? Just at Levashov, I read the information that HIV is not available.

O. He is.

Q. This virus is artificially derived or is it nature?

O. Nature.

V. said that the Americans came up with this virus. It is a myth?

Q. Are there any ways now any ways to keep the disease and effectively deal with it?

Q. What kind of ways?

O. Immunity The most important defender in the body that needs permanent attention, it needs to constantly feed it. In this case, immunostimulation is needed, and not as a one-time, but as a permanent process. Each person has immunity different, therefore there will be different immunostimulating drugs. In all, you need awareness. The person who is realized will understand, for what mistakes, the wrong thoughts and actions, even if he was infected with the clinic, and not the generally accepted and common path, to which we were all accustomed. If a person understands, aware of, will understand, forgive. The psychological moment is very important. The disease always begins on thin bodies, and then on the physical body. First bring changes in thin bodies. There should be a strong awareness in what you are doing. Lead a healthy lifestyle. Avoid the active sun, aggressive ultraviolet, which greatly extinguishes immunity. Healthy nutrition, fresh food, water, full-fledged vacation. Sometimes miracles occur. Until something in the head is changed, the attitude towards the world will not change, the worldview will not change, the result is difficult to achieve. There should always be a comprehensive and holistic approach.

W. Immunity need to raise in advance?

For 30 years of combating the human immunodeficiency virus (HIV), the world has achieved the world achieved in treatment - now patients with HIV can count on antiretroviral therapy, an overwhelming virus in the body to an indefinable level. This reduces the likelihood of HIV transfer to healthy. Despite the fact that it is impossible to completely get rid of HIV, therapy returns patients quality of life and its duration. At the same time, it works as prevention. Therefore, antiretroviral drugs became the main method of combating HIV in Russia. But this is not enough. Without sex education and surveys of the population, increasing adherence to treatment and replacement therapy for drug addicts, not stop in Russia. This was told by the head of the Federal Scientific and Methodological Center for the Prevention and Fighting of AIDS, Academician of the Russian Academy of Sciences Vadim Pokrovsky at the St. Petersburg Forum on HIV infection with international participation, which was held on October 4-5.

HIV in Russia today

As of June 30 of this year, Russia already has 1.27 million HIV infection since the beginning of registration. About 293 thousand people with HIV died, which means now 978 thousand Russians live with this diagnosis. This statistic does not take into account the surveyed anonymously and foreigners located in the country. As Vadim Pokrovsky suggests, now the number of people with HIV in Russia has already reached a million.

59.8% of HIV-infected people were infected with injecting drugs, and 37.1% with heterosexual sexual contacts. In recent years, the epidemic is generalization - the disease has been out of the "key" groups. For example, for the first half of this year, 54.4% of Russians have become infected with sexual contacts, and during drug consumption - 42.8%. 2.1% - with homosexual contacts.

Strategy 90-90-90: Is it possible to defeat HIV by 2030?

As part of the program to combat HIV / AIDS and the consequences of the disease around the world (UNAIDS), a goal is to stop the AIDS epidemic by 2030. For this, a strategy is 90-90-90, according to which, by 2020, 90% of all the living with HIV should be aware of their status, 90% of them will be consistently obtained antiretroviral therapy, and in 90% of the treatment with viral load should be reduced. Understanding.

Arithmetic calculations show that the strategy looks like "90-81-72.9": those 90% that should receive treatment are 81% of the total number of people with HIV, and reduced viral loads want to achieve 72.9% of living with HIV. This suggests that about 27% will remain potential sources of infection. As Vadim Pokrovsky implies, in the first place there will be people who have limited access to medical care (drug users, sex workers, people with mental illness), and those who are at an early stage of HIV, which means have the highest viral load And the risk to infect others.

At the same time, even such a "incomplete" strategy requires serious costs from countries, says Academician Pokrovsky:

- This program is very expensive. When UNAIDS said that the epidemic would be stopped by 2030, everyone heard only this part of the phrase. However, she has a continuation: "If there is enough finance." For some reason, no one speaks about it.

Moreover, even with sufficient resources and efforts, the epidemic can still be defeated by 2030, Pokrovsky is convinced:

- There is the main hypothesis of victory over HIV. According to her, over the years, the mortality from AIDS will decline. It means that the number of HIV living and passing therapy will grow. And only then, when they will die from 70 years from other reasons, the epidemic will really be defeated, as there will be no sources of infection. But this will happen, of course, not by 2030, and after 70-80 years - only with the death of the last identified.

Russian approach: "Test and Leach"

Despite the unique goal of the international program, the Russian methods of combating the disease differ from those that are registered in UNAIDS, Vadim Pokrovsky notes. On the Russian website of the program, the goal is indicated as follows: "UNAIDS seeks to stop the spread of HIV, providing the treatment of all people living with HIV, protecting human rights and defending their observance, spreading information to adopt weighted solutions." However, this version has a discrepancy with the English-language wording, the correct translation of which sounds like "UNAIDS is working to stop new infections, to provide every person living with HIV, access to treatment, protect and encourage human rights and prepare data for decision-making" .

- Apparently, we have a major bet on HIV treatment in Russia, and not his prevention of new infection cases. Maybe this difference for the purposes of the program lies on the translator's conscience and does not have such a meaning, but nevertheless it really reflects the other - the Russian approach to HIV liquidation: "Referring as many people as possible with HIV and Leachi."

Some Russian documents are contrary to this principle, said expert, leading to the example of the recommendation of HIV infection in adults 2017, edited by the Ministry of Health, on which some groups of patients are intentionally limited. According to the document, "it is recommended to postpone the beginning of the ARW in the following cases: in the serious condition of the patient requiring the stabilization of vital functions, or the flow of secondary or accompanying diseases (tuberculosis, CNS damage, oncological diseases, severe liver damage, kidney, etc.); In the presence of mental diseases and severe drug addiction. Due to the fact that in these cases it is impossible to form the necessary level of therapy commitment, it is advised to postpone to "recovery, achieve remission, effective rehabilitation, increasing commitment." At the same time, the very concept of "severe drug addiction" does not happen, says Pokrovsky: it is either there or it is not.

- While in all countries they want to start therapy at once, on the very first day after detection, we try to postpone it, although 60% of HIV living with HIV have been infected due to drug use. We ourselves limit the implementation of the Strategy "Test and Leach". I revealed, but we will postpone the treatment until it cures drug addiction. Now only 713 thousand people are 71.7% of the number of all HIV-infected people on dispensary register. Only for the first half of 2018, 51.7 thousand new cases were revealed, but only 42 thousand were released on the dispensary account. Again the big difference between the identified and registered. What the remaining 30% do is not clear.

At the same time, the coverage of treatment in Russia is even lower - 38.1% of the number living with the diagnosis of HIV and 53.1% of the number in the dispensary accounting. In the first half of the year, 378.5 thousand people received antiretroviral therapy, but 15.7 thousand interrupted treatment, provided the data from Vadim Pokrovsky:

- This suggests that the commitment of treatment is very low. Given that most people with HIV are drug users, special efforts to work with this group of population are required.

ARVT as HIV Prevention

Another strategy of Russia in the fight against HIV is the appointment of ARVT to healthy people exposed to the risk of infection, tells Vadim Pokrovsky. Prevention is postcant and prexact. The first is also called emergency - it is prescribed within 72 hours after a risky contact. Preconctor therapy implies constant reception of drugs with "risky behavior" (unprotected sex, injecting drugs).

Now included in the new edition of the clinical recommendations of the National Scientific Society of Infectilationists, but, according to Pokrovsky, this approach still does not solve the problem. It is estimated that even with high commitment to prevention, men who have sex with men, the effectiveness of precipact therapy reaches 95%. And these are the highest rates. In the heterosexual group, the maximum efficiency is 90%, and at low therapy commitment - 62-78%. In drug users, the effect of prevention is 75%, even if a person regularly takes drugs.

- It is impossible to say that precipact prevention is absolutely reliable method. It suggests that a healthy person should take antiretroviral drug daily, so as not to infect HIV, says the expert. - Very much depends on the commitment to such regular reception of drugs. At the same time, not everyone can afford it.

HIV in Russia tomorrow

- With an existing approach, the number of new cases of HIV infections in Russia will grow. With such measures, I never see the prospects for the victory over HIV. Most likely, Russia is waiting for only hard work on the treatment of an increasing number of patients with HIV in need of therapy, "says Vadim Pokrovsky.

You can stop the epidemic in Russia - if we use the "full preventive arsenal". For this, as the expert told, in addition to pre- and post-contact prevention, the population must teach less dangerous sexual behavior, handing out male and female condoms.

Testing should grow, but it is impossible to ignore patients consulting, Pokrovsky is convinced. Now according to the law, before each survey on HIV with the patient, consult on the risks, prevention and features of the disease should be held. But this is not respected everywhere. At the same time, it is the need to advise a person before HIV test that becomes the reason why patients are not sent to the examination in the primary link - the doctors simply lack at this time.

Antiretroviral therapy should cover all, and not 90% of all identified, says Vadim Pokrovsky. For this, it is necessary to develop a commitment among drug users, to which most of the HIV-positive. Special programs will help solve this task, which in Russia still do not find support.

- Harm reduction programs are very important (issuing new syringes - Approx.) and replacement therapy for drug users. People will come for a dose and at the same time get preparations from HIV. The effectiveness of this method has long been proven in many countries, but in Russia there is a prejudice against such therapy. As a result, we have no commitment to treatment in this group of HIV-infected.

To combat Russia's infection, you need to connect a scientific community. In parallel with all measures - therapeutic and preventive, it is necessary to develop studies on the development of methods of fulfilling HIV or vaccines that protect against infection.

"But even in such conditions, the epidemic will not quickly eliminate the epidemic - so that all measures began to work, should pass a lot of time," Pokrovsky is convinced by Vadim.

Tatyana Host

Dr. Peter.

When in the mid-90-hodges, for the first time, it was possible to achieve a stable reduction in the viral load to an undetectable level, many hoped that anti-rapid therapy would be able to completely defeat HIV over some time. Alas, it soon turned out that with the cessation of drug reception, the viral load soon begins to grow. The cause of the virus stability is in its ability to hide in "sleeping" cells, so-called latent tanks.

The main directions of studies are three. This is a preventive vaccine, the activation of the virus in latent tanks and gene therapy. Let us dwell on each details.