Difficulties and opportunities in curing HIV discussed at this year’s HIV conference

Published 2016-12-15 14:26. Updated 2016-12-15 14:38Denna sida på svenska

The HIV & Hepatitis Nordic Conference was recently held at the Hilton in Stockholm. The conference was co-chaired by Professor Anders Sönnerborg, Unit of Infectious Diseases and Dermatology.

Tell us about this year’s conference. Which main issues were discussed?

- Once again, this year’s conference was a great success. We had 290 participants – the highest number to date – primarily from Sweden and the Nordic region, but also from the Baltic states, the US, Italy and a number of African countries. We don’t intend to grow any bigger. Part of our success lies in the fact that we’ve created a platform for meetings between preclinical and clinical researchers and physicians, with the hope of creating new rectilinear projects. The main draw is five to seven international invited speakers at the cutting edge of HIV and hepatitis research, says Anders Sönnerborg.

- This year, the focus in terms of HIV was on two diametrical questions: aspects of the difficulties but also the opportunities in curing HIV. We heard about the problems in connection with exhaustion – the immune defence’s inability to eliminate the remaining limited quantity of HIV in the body, and possible opportunities for kick-starting these cells. There was also an excellent review of the opportunities and ongoing projects for curing HIV with gene therapy.

What is the HIV situation in Sweden today?

- I’ve developed a health information tool, InfCare HIV, which is linked to patient notes. It’s used at all Swedish HIV clinics and includes more than 99% of diagnosed patients, making it unique. All the data is updated electronically in real time. This means that we know exactly how many patients there are in Sweden. So on Tuesday 25 October, there were 7,171 patients. 98% are currently being treated, and 95% reach the treatment target – a world-leading figure. The number of newly discovered cases has fallen over the last year, but from a longer-term perspective there’s no clear trend. This is partly due to the streams of migrants having a significant effect on incidence.

What do you think needs to be done within our field?

- Despite our great successes within the field of HIV, there’s a lack of fundamental knowledge about pathogenesis – the way we describe the origin and development of disease. This might perhaps be thought less interesting in the light of our successes, but the central objectives – cure and vaccine – are still a long way off. Unfortunately, the situation is getting worse again from a global perspective. 36 million people have died, 38 million are infected, and another 5,000 are infected every day. The initial successes in low-income countries are now starting to give way to increasing problems, for example with pharmaceutical resistance. So there’s a lot to get to grips with.

What are you and your team researching right now?

- Our focus is on three main areas: 1) Understanding the mechanisms of HIV persistence and latency in the cellular reservoirs (particularly resting memory cells) and how we can eliminate these cells. 2) The molecular properties of the subtype that is spreading fastest globally, HIV-1 subtype C, which my research team first identified in the late 1980s in Ethiopia, and which now accounts for more than 50% of global infections. 3) Studies of a more epidemiological nature, focusing on understanding the spread of infection within Sweden and developing methods for characterising the hidden epidemic, i.e. those individuals who have been infected but not yet diagnosed.

Background - Anders Sönnerborg
Why did you specialise in HIV?
- Why not? I can’t imagine a more interesting, exciting and rewarding job. I’ve always been fascinated by the interaction between humans and nature/animals (including tiny microbes), and I’m also interested in other cultures and new discoveries. I travelled around the world a lot in the past and got a taste for it. Until the HIV epidemic, infection medicine was satisfied with people who turned up very sick, including young people, going home again a few weeks later completely healthy. So when young HIV patients began showing up and dying of AIDS, it was a real challenge to ‘make things right’ again. And it’s no secret that it was incredibly exciting to encounter a new epidemic that we didn’t know the cause of to begin with – the great challenge for a specialist in infectious diseases. It gradually became clear that the work involved in HIV was so extensive: a new virus, new knowledge about immune defence, the advent of antiviral treatment which was virtually unknown before, etc., combined with the enormous consequences for society, not least how people reacted to those with HIV and the psychology behind it. So now I’ve seen the HIV epidemic go from 100% mortality to a treatment that gives HIV patients a lifespan approaching that of people who are not infected with HIV. The final nail in the coffin for HIV would be helping to develop a way to induce a functional cure, but there’s still a long way to go yet before I can hang up my hat.