December is AIDS Awareness Month, a key opportunity to raise awareness of the disease as well as celebrate the success of treatments and prevention services. The Drexel University College of Medicine’s Division of Infectious Diseases and HIV Medicine is a highly regarded HIV/AIDS research program.
The program is focused on working toward a functional cure of the HIV infection.
“The medicines out there are great and work tremendously well to suppress the virus and build up the immune system, but we’re working toward a definitive solution,” Jeffrey M. Jacobson, the chief of the Division of Infectious Diseases and HIV Medicine, said.
There are three different approaches in terms of an HIV cure. The first is to kill the HIV-infected cells in the body, the second is a functional cure to re-educate the immune system, and the third is to make cells resistant to HIV infection. Drexel’s program focuses primarily on the second approach.
The research team is taking immune-based and gene therapy-based approaches to find a functional cure to control the virus. The focus is on boosting and re-educating the immune system by not expressing the HIV virus or doing any harm to the patient. The immune system is already able to do this with other viruses, such as chickenpox. Society has learned to live with chickenpox because the immune system can control it.
“We are interested on why the immune system has become so damaged [by HIV] and why [the immune system] is not able to control the infection as with other viruses, and whether that defect in the immune system is reversible by vaccines and other immune-based therapies,” Jacobson said, “It’s not an easy line of research. There are some hints of progress, but it’s going to take a lot of work.”
The team is working with antibodies against HIV, particularly ones that inhibit the infection’s entry into cells so it can’t infect them. This would be long lasting and useful in patients who are not able to take oral medications.
“There are patients who don’t take their medication because they are forgetful or don’t care about themselves enough. This is another way to treat patients who aren’t benefiting from current treatments and will protect them from spreading it to others,” Jacobson said.
The first approaches focuses on HIV’s active replicating cycle, which creates viral DNA that integrates into the host cell DNA and establishes a latent infection in memory T cells. When those cells are treated, there is still a population of cells that contains the HIV gene, which is why the virus returns when patients stop treatments. To find these genes, the cells need to be expressed, and then they can be targeted and killed.
The program is working with the University of Pennsylvania on the third approach, a gene therapy study to prevent HIV infection in cells. The study involves taking an HIV-infected patient’s lymphocytes and loading them with genes that make the cells resist the infection.
In addition to improving treatments, the program is heavily involved in prevention efforts. The program is working with community programs to help identify people who are infected and get them to care, as well as making sure patients who have fallen out of care get back to it. Patients who have drug and alcohol problems are an additional concern because those substances interfere with treatments. This is all an effort to control the epidemic and stop the spread of HIV.
“AIDS is a major epidemic; students should know about it just for that reason. Students should be aware that for several years the Center[s] for Disease Control [and Prevention have] recommended routine opt-out testing for ages of 18-65. That means HIV testing should be part of their routine care. Students should be tested if they haven’t been. They should be aware of that and spreading the word that everyone should be tested,” Jacobson said.
AIDS.gov reports that over 1 million Americans are living with HIV, but 20 percent of them are unaware of it. Every 9.5 minutes someone in the U.S. is infected.
“There’s a need for new ideas and new people to get involved and energize the field on the research level, community level and public health level,” Jacobson said.
Drexel’s research program has the largest care program in the Philadelphia region with a multidisciplinary integrated approach. Along with clinicals, there are social workers, psychiatrists, pharmacists, nutritionists, a women’s care program and more. It is set up as a miniature health care system with government funding.
The current studies involve close collaborations with the Department of Microbiology and Immunology, the Department of Emergency Medicine, and the School of Public Health. They also collaborate with smaller biotechnology and pharmaceutical companies on creating innovative approaches to cures.
Drexel’s research team is funded by the National Institutes of Health.