The Evolution of HIV Treatment: From AZT to PrEP and the Search for a Vaccine

AZT was the first treatment for HIV. It acted on the activity of an enzyme that slows down the replication of the virus.
Then triple therapies were implemented, which over the years have become more accessible throughout the world.
We are still waiting for an HIV vaccine.
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The human immunodeficiency virus (HIV), long considered deadly, has become a chronic disease thanks to triple therapy. Its had an evolution over the decades, although the development of a vaccine is still pending.

That achievement cannot yet be reached due to the mutating capacity of the AIDS virus.

Next, we tell you how HIV treatment has evolved.

THAT

When HIV appeared in the early 1980s, patients were doomed to die in the short to medium term. No medication seemed to work, until AZT came along.

Actually, azidothymidine was initially synthesized in the 1960s as a potential cancer treatment. However, it was abandoned due to a lack of convincing results.

Against AIDS, the American laboratory Burroughs Wellcome —owner of the molecule— tested it in a clinical trial that was stopped in phase two, one before commercialization, because the results were good.

On March 20, 1987, the first AZT antiretroviral treatment was authorized in the United States, which acted on the activity of an enzyme called “reverse transcriptase”, which slows down the replication of the virus.

Unfortunately, AZT had significant side effects. Later it was learned that it was insufficient to treat HIV, since it only acted in one phase of virus replication.

triple therapies

An important event occurred in January 1996 with the international conference on retroviruses in Washington. In this positive results of several tests carried out by laboratories were presented.

It was the arrival of a new class of drugs, antiproteases, which are molecules that prevent another stage of HIV replication by blocking the maturation of new proteins in the virus.

These molecules, combined with other antiretrovirals, completely changed the game.

“By targeting three stages, three molecular targets, it makes it much more difficult for the virus to escape treatment,” explained researcher Victor Appay, an immunologist and director of research at the National Institute for Health and Medicine Research in France.

Initially, the therapies were very expensive and were reserved for rich countries. Today, they have become more accessible thanks to a commitment signed in 2001 at the World Trade Organization to allow developing countries to manufacture generic drugs.

There are currently five major types of antiretroviral drugs that act at different phases of viral replication. In addition, more and more work is being done so that the treatment is much less burdensome, with less frequent doses.

PrEP

On July 16, 2012, a first treatment called PrEP (pre-exposure prophylaxis), the antiretroviral cocktail Truvada, was licensed in the United States.

Since then, this type of treatment has proven its effectiveness and allowed people at risk to protect themselves by taking a preventive pill.

transplants

There have been three full recoveries of HIV patients through transplantation. Patients suffering from blood cancer received stem cell transplants that completely revamped their immune systems.

The donor had a rare mutation in a gene called CCR5 that prevents HIV from entering cells. However, these transplants have only been done in rare cases, not all patients.

A possible HIV vaccine

This is the treatment that has been expected for four decades. The difficulty is that HIV has a powerful mutability and innumerable subvariants, allowing it to evade the little soldiers of the immune system.

It can become invisible, hide in reservoirs, and appear in the following years.

So far, attempts to develop a vaccine have failed, but work continues. A new approach is the induction of antibodies in the person through a vaccine that protects them from infection.

“That’s the main hope,” Victor Appay said. “A lot of research is being done to generate broad-spectrum antibodies that target as many strains of HIV as possible.”

* With information from AFP.

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