A small clinical trial of a therapeutic HIV vaccine temporarily lowered
viral levels in HIV-positive participants. While
the study is highly preliminary, it gave the Spanish researchers, a “proof of
concept,” suggesting that their strategy may one day lead to a
“functional cure,” in which people with HIV could suppress the virus
without the need for daily antiretrovirals (ARVs).
The
researchers created vaccine effect by modifying the
patients’ own dendritic cells. These are immune cells that prompt CD4s
to fight pathogens—but they can also carry HIV and transmit the virus to
CD4 cells. The scientists pulsed the participants’ dendritic cells with
HIV that had been drawn from their bloodstream and deactivated with
heat. Out of 36 participants, all of whom were taking long-term ARV
therapy, 24 were randomly assigned to receive three injections of the
manipulated cells and 12 received three doses of ordinary dendritic
cells. Afterward, all participants stopped taking ARVs for 48 weeks.
After
12 weeks of ARV cessation, 12 out of the 22 participants who remained
in the treatment cohort had a 10-fold reduction or greater in what’s
known as a plasma viral load set point, while only one out of 11 in the
control group experienced such a benefit. Following an additional 12
weeks, seven out of 20 participants still within the active therapy
group maintained a 10-fold reduction in their viral load set point,
while none in the control group experienced any sustained therapeutic
effect. The viral load reduction was consistently associated with a rise
in CD4 counts.
The vaccine proved safe and well tolerated. Eventually,
however, all the participants saw their viral loads rise again.