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HEALTH Read on about the latest findings and highlights of CROI 2012 HIV Report with Specialist Filippo von Schloesser Words by Filippo von Schloesser means prevention, and starts a new appealing perspective on how to control, or at least to diminish the spread of new HIV infections —even with the lack of a preventive vaccine. A lot of clinical trials that have been HIV therapy: To What Extent does it Work? The treatment for HIV has reached unexpected results in terms of blocking the virus, replication in the blood, and the preservation of the immune system of people affected by this infection, but nevertheless the research thus far has not been able to determine how to neutralize or kill the virus, once and for all. Among the discoveries over the last three decades, "treatment is prevention" is the latest concept that came out and caught the attention of policy makers and researchers, as recent clinical trials have confirmed that people who take the antiretroviral therapy correctly do not spread the HIV virus, if they have undetectable levels of viral load. I've reported on this important aspect since 2008, when the Swiss guidelines on HIV therapy had stated that sero-discordant couples who had unprotected sex, reported not to have infected their partners, opening new intriguing perspectives. Through these discoveries, since the International AIDS Concerence of Vienna in 2011, the motto became: Treatment is prevention. PrEP - Pre Exposure Profylaxis: A Key Concept to Prevent The treatment of HIV positive adults also recently developed show that the uninfected people who practiced risky sexual behavior and received two antiretrovirals for the period in study, did not get infected —thus reinforcing the success of the theory that treatment is prevention, not only for sero- discordant couples where the positive one is on treatment, but also for HIV negative people who are exposed and are at the risk of getting infected (IPrEx study, STRAND, FEM PrEP, HPTN 052…presented and discussed at CROI 2012 in Seattle). More studies are being planned to understand the efficacy of this strategy, employing the use of antiretrovirals twice a week to induce the body to protect and prevent the entry of HIV in an uninfected person, in the long term. Still, there are many questions that need to be answered. Firstly, how reasonable is it for someone who does not need a cure for the disease to ingest a medication that may have side effects —when simply subscribing to a more cautious behavior might be a better option? And in the real world, how many people regularly use condoms in the beginning of sexual relations? How practical is it to believe that people will fully respect their treatment schedules and never forget a single dose of their medication profylaxis? In these months, the CDC in Atlanta elaborated on the recommendations and guidelines for the correct implementation of the PrEP in heterosexuals. In January 2011, the guidelines for men who have sex with men were published. I have already reported on PEP, post exposure profylaxis, the tool that can be implemented a few hours after somebody has an accident, either by injection or sexual exposure, and might have been in contact with HIV (www.thebody.com, and check also the CDC guidelines). Working toward a Cure The concept of "eradication" was raised a couple of years ago by researchers who have the complete process of elimination of the virus from the body of HIV infected people in mind. The major objectives of eradicating are: 1) To clean the reservoirs of latently infected cells, also of the proviral DNA to reach the total absence of the virus in the body (and not only in the blood as nowadays). 2) To get a totally functional immune system. 3) To guarantee the absence of new transmissions. Taking into consideration that with the antiretrovirals in the armamentarium of the therapy these tasks are not achievable, the research is looking forward to two possibile strategies: 1) Gene therapy, which is very complex as it aims at the modification of the genetic language of the cells in the body, 2) More realistic and prospective is the pharmacological one: it would drive out the virus from the hidden compartments such as the brain, kidneys and lymphonodes and drive it back into the blood and kill it with the antiretroviral therapy. Various existing medications are in study, among them, at CROI Vorinostat, acetylase inhibitors, rifaximin... More were mentioned, but thus far no results have been achieved, though new studies are being planned. One of the problems to be resolved in this context is the definition of the markers that will prove the success of this strategy as the classical markers linked to the study of the blood are not adequate to analyze the achievement of the eradication objective. A very appealing dream for the next years is that science is often based on intuition, that bring changes. ML MIAMI LIVING 83