Brad Jones, of George Washington University, spoke to us at the HIV Endgame conference and answered questions about cure research.
The HIV Endgame conference logo appears on screen. Text reads: Brad Jones answers questions on HIV cure research. Brad Jones sits in front of a wood-panelled wall and answers questions from off-camera interviewers. The text of each question appears on screen between clips.
Brad Jones: So, my name is Brad Jones. I’m an Assistant Professor at the George Washington University where I’ve been for just over a year, so it’s fairly new. Before that, I was at the Regan Institute at Harvard and MIT. And my work focuses on figuring out how we can harness part of the immune system called cytotoxic t-cells to try to eliminate HIV reservoirs. So, what we’re really focusing on is, can we get closer to curing people? And — so that lifelong antiretroviral therapy is not needed anymore.
Q: What kinds of cures are we investigating right now?
Jones: I think that, in general, people might be shifting a bit from talking about sterilizing cures to talking about these functional cures, where maybe the virus isn’t completely eliminated but the immune system can control it. I think, in reality, it’ll be really hard to know whether we’ve actually achieved a functional cure or sterilizing cure, because, if the virus doesn’t come back, then how do you know it’s completely gone? But I think the shift has been driven, really, by making sure that we’re setting realistic expectations that we can meet in a timely fashion. And I think this idea of remission, where people can stop therapy for certain amounts of time, is something that’s going to be more achievable in the short term.
And what I would also pitch, myself, is maybe something that hasn’t completely caught on in the field, but something that I’ve been thinking about a lot more lately is maybe getting people off of therapy is not — should not be the only goal, essentially, of cure research. Because, I think that if we can reduce the viral reservoirs, even if we can’t stop therapy, maybe that’s going to reduce some of the comorbidities that continue to persist. So, some of the cardiovascular disease, and neurocognitive disorders — maybe that’s another way of of thinking about it. Improving health, improving quality of life further through new biomedical tools, even if people need to continue with therapy for now. So, that’s another another angle.
But I think none of these things should be really thought of as silos. I think people working towards a functional cure are going to find things that can assist in a sterilizing cure down the road, and, as long as the lines of communication are open, and people are talking to each other, there’s going to be exchanges both within the cure research and, I think, this is also going to inform vaccine development and vice versa. So, it’s nice to have this this diverse set of aims.
Q: What about cures that might be risky or dangerous?
Jones: The short answer is that those avenues of exploration are just not being explored. And, the FDA right now, to my understanding — I should preface it by saying I haven’t set up a clinical trial, but from from what I hear — when they are weighing the risk-benefit ratio, basically, to see if a trial can move forward, they consider someone living with HIV who’s suppressed on therapy to be a completely healthy individual. So, the tolerance for risk is very, very low.
So, there are a lot of potential therapies that might have some relatively minor risk associated with them, which also can’t move forwards. And maybe that’s exactly the right approach; maybe that’s correct. But, if the community feels that different aspects of living with HIV are not being weighed fully in those balance sheets that they’re putting together, then I think there’s a space, also, for advocacy — which, of course, the community living with HIV has a tremendous history of — in communicating with these regulatory agencies and kind of helping to to steer that risk-benefit ratio. But, I think, yeah.
The short answer is that anything that would be considered to have really severe side effects it’s just not — it’s just over before it starts.
Q: How does the search for a cure affect HIV stigma?
Jones: An interesting lesson for me that came from one of these OHTN meetings was, we were presenting a kind of military analogy for killing the virus. “We are going to…” I don’t even remember what it was — what it was exactly but, you know, the immune system lends itself to military analogies because you have t-cells and foot shoulders and everything like this. And the point that was made, and I think it’s a point many people are aware of, is, if you — anytime you engender fear against the virus, you engender, to some extent, fear against people living with the virus. So, I think, in the same vein, if you say that we need to cure people so that people aren’t stigmatized anymore, then maybe that seems to validate the stigma in a way that it shouldn’t.
So, I’m way outside of my area of expertise, here, but also, I think just the concrete evidence of how attending these conferences with community members and stuff does shape, in some ways, the way that we think. So, we listen when people make comments like that. Or, at least, I hope that most of us do.
Piano chords play as the OHTN media logo appears.
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Note on content: Interview questions have been edited for brevity.