“There’s a lot of hope”: Courage and community drive latest efforts in HIV cure research
The first of two HIV cure research trials has concluded at The Alfred, as researchers continue their search for new ways to improve treatment of the disease.
“There’s a lot of hope,” says Associate Professor James McMahon, Head of Clinical Research in The Alfred’s Department of Infectious Diseases, responding to the recently published results of the first trial, co-led with experts from Denmark and known as TITAN.
TITAN, is the first of the two new trials being conducted by members of The Alfred’s Infectious Diseases team, aimed to determine if drugs involved in the treatment of other medical conditions could also play a positive role in the treatment of HIV.
“[The TITAN trial] gave two different treatments – one of them were antibodies that target HIV and one was another drug that sort of soups up or fires up the immune system to try and fight anything that’s left over,” says A/Prof McMahon. “[The study] was important for us because it was the first study we’ve done here where we were safely stopping people’s normal antiviral treatment and were monitoring them and watching for their virus to come back in their blood.”
“To my knowledgee, these are the first cure-focused treatment interruption studies done in Australia,” adds Dr Jillian Lau, an Infectious Diseases physician at Alfred Health.
“The treatment interruptions are a unique aspect of both of these trials.”
Both A/Prof McMahon and Dr Lau are especially conscious of the challenges involved with asking participants to temporarily abandon their existing treatments – even while under the careful supervision of the clinical research teams.
“If you’re someone with HIV, one of the first things you’re told is that if you get on these antiviral medications, you’ll have this normal, long, healthy life,” A/Prof McMahon describes. “You’re also constantly reinforced to take them all the time and told if you stop them your virus will come back.”
“Clearly, it’s a huge psychological barrier to do it.”
“But we're doing this so that we can try and understand a certain endpoint, result or impact of these interventions in the study,” adds Dr Lau. “It’s necessary at the moment in terms of where we are in HIV cure science to see what happens when we stop HIV treatment to determine if the drug that we're testing or the intervention that we're testing has any true impact.”
"And essentially the antibody therapies that were given did significantly delay, by months, the amount of time that the virus took to come back," says A/Prof McMahon, reflecting on the results of the TITAN trial as he and his team now turn their attentions to the second of the two planned studies – with The Alfred’s clinical research team to play an even more prominent role.
This newest trial, referred to as NIVO-LD, will see voluntary participants provided with a low dose of a drug known as Nivolumab which is currently in use in the treatment of various types of cancer.
“NIVO-LD is a study that we’re leading from Melbourne, and a close collaboration between the Doherty Institute and The Alfred,” explains A/Prof McMahon. “There’s a lot of previous data from other studies in people with HIV that [Nivolumab] can increase the body’s immune response towards the virus.”
“What we’re really interested in is can we use a very low dose to improve its safety profile to get that increased response towards HIV, and these doses are extremely low compared to what’s used to treat cancer.”
“The drugs that we have at the moment stop [HIV] from multiplying, stop it from infecting new cells, stop it from causing further illness and can lead to someone with HIV having a long, healthy, normal life,” says Dr Lau. “But what we're trying to do is cure HIV [and] eliminate that need for having to take regular medications.”
And, as both A/Prof McMahon and Dr Lau suggest, nothing drives this pursuit more than the courage of the community of patients with HIV and their own commitments to a search for answers – and for hope.
“I always find that really amazing,” says Dr Lau. "That drives me - that's what I do this for because the people keep asking what's the next one [and] when? When can I contribute to the next study? I'm always amazed by people's willingness to kind of give to science and seek the same answers we do even when we're at this very early end of all of this.”
“There's [a] huge drive that we get from communities saying that they want this. They need this. And that's what pushes me along.”
Volunteers interested in participating in the NIVO-LD trial and being a part of this research can contact 03 9076 6908 or visit https://classic.clinicaltrials.gov/ct2/show/NCT05187429 for more information.
