Antiretrovirals have revolutionized the approach to AIDS, which no longer kills people who are on treatment. But research continues to simplify medications.
There is no cure for HIV. The advances made for more than 20 years on the side of treatments sometimes lead to forget it. They work well, stabilize patients and lower the viral load. So much so that their discovery and democratization are largely responsible for the 45% drop in the number of deaths linked to the infection since 2005.
But stopping antiretroviral treatment always means that the virus will come back. While waiting for the arrival of a truly effective vaccine, they are still the only medical bulwark, and must be taken for life, every day. Maybe not for a very long time.
Spaced outlets
Adaptations of the galenic – the form in which the drugs are taken – are being studied, to reduce the burden of taking treatments. “Fewer drugs, fewer constraints”, sums up for Why actor Prof. Pierre-Marie Girard, head of the infectious and tropical diseases department at Saint-Antoine hospital, and specialist in HIV.
From dozens of medications to swallow per day, treatments have already been simplified to be limited to a daily pill. But laboratories continue to innovate. “We are seeing the emergence of very long-term treatments, including injectable form,” explains Prof. Girard. Prevention and treatment could be based on quarterly or even half-yearly injections. It could represent a small revolution. “
For soon
By different methods, including the use of nanotechnologies, the molecules will be delivered continuously, adds Professor Girard. And this is not science fiction. “Clinical trials are underway to validate these new treatments,” he continues. Small implants, which could be worn for a year, are also in development. “
Their arrival on the market should not take too long. The trials are in their final stages, and the doctor estimates they could appear within two years. One more step to promote the quality of life of patients.
Towards remission
But the therapeutic holy grail, what researchers have been trying to achieve for many years, is a cure. And, on this side, we will still have to wait. “We are looking in all directions, but we do not succeed”, regrets Professor Girard.
The goal, for now, would be to find treatments that do not necessarily lead to recovery, but at least to remission. After a phase of treatment, the viral load would be zero or undetectable, in the long term, without the need to continue the drugs. As with cancer, when the disease is on the decline, specific follow-up would nevertheless be necessary, in order to monitor a possible relapse.
Global scientific success
The current treatments are already a real opportunity. The sudden and spectacular emergence of AIDS in the 1980s mobilized researchers around the world, who set out to find solutions. And, after barely more than 10 years of research, the first antiretrovirals, admittedly less effective than current treatments and with more side effects, were created in 1995. This represents a record for the management of this condition. type of disease.
The life expectancy of people living with HIV is now equivalent to that of the rest of the population. Their quality of life is also almost similar. The morphological changes observed with the first antiretrovirals, especially in the face, seem to have been forgotten. “I still say it cautiously, but it is ancient history”, according to Professor Girard.
Digestive problems at the start of treatment, vascular and metabolic risks (diabetes) are well known and anticipated. With prevention, they can be managed. On the other hand, the increased risk of cancer is more difficult to manage. The researchers are also looking at possible neurological damage: depression and early Alzheimer’s disease could be attributed to the treatments.
These consequences serve as a reminder that HIV remains a dangerous infection. Much effort must still be made for its eradication before 2030, desired by UNAIDS, which considers the task possible. But not everything can be based on treatments.
Science is not everything
“We still need basic research,” recalls Professor Françoise Barré-Sinoussi, 2008 Nobel Prize for Medicine for his co-discovery in 1983 of the virus that causes AIDS. The efforts made for more than 30 years have prolonged the lives of people living with HIV and reduced the number of infections.
But to date, still 37 million people are infected with HIV worldwide. The virus still kills a million people a year, and infects 2 million people. Almost half of those living with HIV don’t know they are, and only half are on treatment.
“We talk about it a lot less, but the epidemic is still there,” insists the researcher. To eradicate it, a vaccine will be needed. But the priorities are not only scientific ”. AIDS and HIV have an indisputable social significance.
A scope that is found in the slogans used for awareness campaigns, believes Professor Barré-Sinoussi. While, until the mid-1990s, before the arrival of the first antiretrovirals, the watchword was sacred international union, particularly on research, they quickly targeted discrimination. From “Join forces” in 1991 to “Live and Let Live” in 2003, the spirit of the struggle has changed. More recently, it is North-South inequalities, particularly in access to treatment, that have been attacked. In 2014, the theme for the World Day was “Closing the Gap”.
It is also on this side that the fight must progress, to meet the objective set by UNAIDS. And international harmonization will require a lot of effort. “We need to better educate, strengthen health systems, improve national policies, coordinate care and screening, promote early treatment,” says Professor Barré-Sinoussi. We must also insist on tolerance. Even today, more than 70 countries around the world have laws that discriminate against people with HIV. This is unacceptable. “
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