A new direction in HIV therapy

HIV is a worldwide problem – 35.3 million people are living with HIV or AIDS and 36 million people have died from AIDS related illnesses1. As the HIV/AIDS epidemic is such a big problem, there are many agencies working hard to come up with effective and efficient treatments. In a recent seminar at Macquarie University’s Australian School of Advanced Medicine, Professor Anthony Kelleher discussed the cutting edge HIV research his team has been conducting. His research at The Kirby Institute, University of NSW, focuses on how HIV reservoirs are established and maintained and how this information can help to develop a cure.

Currently, the only option for HIV treatment is the use of antiviral therapy. This treatment suppresses the replication of HIV virus particles by targeting different stages of the virus lifecycle, such as the entry of the virus particles into the cell, creation of DNA from virus RNA, insertion of the virus DNA into the cell’s nuclear DNA or preventing mature virus particles from leaving the cell (Figure 1)2.

Figure 1. Anti-viral drugs target different stages of the HIV lifecycle.

Figure 1. Anti-viral drugs target different stages of the HIV lifecycle.

Antiviral therapies work well, but they don’t eliminate the virus from the body3. As soon as patients stop anti-viral drug treatment, HIV levels can rapidly rise due to the stockpile of virus particles lurking in cells (the viral reservoir)4. This means patients with HIV need anti-viral drugs for the rest of their lives, otherwise the virus will return with vigor and the patient will relapse (Figure 2).

Figure 2. HIV+ patients currently take a cocktail of drugs to suppress the virus.

Figure 2. HIV+ patients currently take a cocktail of drugs to suppress the virus.

Staying on anti-viral drugs for a lifetime can have a lot of unwanted side effects, such as metabolic diseases and osteoporosis5. There are research teams developing a vaccine for HIV, but this is still in phase 1 of clinical trials (preliminary safety tests). A vaccine needs multiple rounds of trials and will take approximately 15 years before it can be used in the general population6.

Only one person has been cured of HIV – a patient with HIV developed an additional disease which required a bone marrow transplant. The bone marrow donor had a deletion of his CCR5 gene, a receptor for HIV. As the HIV receptor was no longer present the HIV could no longer bind and the patient was cured4. Unfortunately, a bone marrow transplant from a donor with a CCR5 gene deletion is not an option for everyone with HIV, so other avenues are being explored.

Professor Kelleher and his team are interested in developing alternatives to long-term medications and are looking at the genes of HIV and the immune system for a possible solution. The team has just recently received ethics clearance to start human clinical trials using siRNAs (small interfering RNAs) to degrade the CCR5 gene receptor for HIV. This method aims to stop expression of the HIV genes (silencing) which stops the virus particles from replicating7 (Figure 3). This will remove the viral reservoir, but the genes will still be present in the patient’s genome. This method has been effective for other viruses, such as the Human Papilloma Virus, Polio, Hepatitis B and Hepatitis C, and oncogenes have also been silenced using this method8,9.

The way retroviruses, such as HIV, replicate is by inserting their genetic material into the host cell’s genome and taking over the DNA replication machinery to produce messenger RNA and then proteins. The siRNAs can bind to the HIV messenger RNAs (Figure 3) and degrade them, stopping the creation of the proteins that create HIV particles10. Alternatively the siRNAs can bind to the DNA and change the chemical structure so the HIV genes can’t be transcribed4. The siRNAs are so specifically targeted to HIV strains that there is no chance of detrimental impacts on other genes10.

Figure 3. siRNAs degrade messenger RNA so it can’t be translated into protein (McManus & Sharp 2002).

Figure 3. siRNAs degrade messenger RNA so it can’t be translated into protein (McManus & Sharp 2002).

Another research group has shown that treatment with siRNAs works to silence an HIV-type virus in mice11 so the next step is to try this method with human HIV. Professor Kelleher’s team will start the treatment with a small group of HIV patients, following these steps:

  1. Identify HIV+ patients currently taking anti-viral drugs to suppress the virus;
  2. Treat with siRNA therapy;
  3. Stop anti-viral treatment; and
  4. Monitor the patients to see if the HIV stays suppressed.

If the HIV symptoms don’t return then the siRNAs have eliminated the viral reservoir and silenced the HIV. The siRNA treatment has been shown to be effective in human cells for up to 30 days in a laboratory setting. If the same is shown in human clinical trials, this could lead to a significant improvement for the quality of life for millions of HIV+ patients in the future.

Want to know more?

  1. World Health Organisation (2014.) HIV/AIDS, http://www.who.int/gho/hiv/en/, accessed 22 May 2014.
  2. Mehellou Y & De Clercq E (2010). Twenty-Six Years of Anti-HIV Drug Discovery: Where Do We Stand and Where Do We Go? Journal of Medicinal Chemistry, 53(2), 521-538. doi: 10.1021/jm900492g.
  3. Suzuki K, Marks K, Symonds G, Cooper DA, Kelleher AD, et al. (2013). Promoter targeting shRNA suppresses HIV-1 infection in vivo through transcriptional gene silencing. Molecular Therapy – Nucleic Acids, 2, e137; doi: 10.1038/mtna.2013.64.
  4. Kent SJ, Reece JC, Petravic J, Martyushev A, Kramski M, et al. (2013). The search for an HIV cure: tackling latent infection. The Lancet, 13(7), 614-621. doi: 10.1016/S1473-3099(13)70043-4.
  5. Grund BA, Peng GA, Gibert CLB, Hoy JFC, Isaksson RLA, et al. (2009). Continuous antiretroviral therapy decreases bone mineral density. AIDS, 23(12), 1519-1529. doi: 10.1097/QAD.0b013e32832c1792.
  6. National Health and Medical Research Council, Commonwealth of Australia (2014). Australian Clinical Trials. http://www.australianclinicaltrials.gov.au/node/5, accessed 22 May 2014.
  7. McManus MT and Sharp PA (2002). Gene silencing in mammals by small interfering RNAs. Nature Reviews Genetics, 3, 737-747. doi: 10.1038/nrg908.
  8. Saleh MC, Van Rij RP, Andino R (2004). RNA silencing in viral infections: insights from poliovirus. Virus Research, 102, 11–17. doi: 10.1016/j.virusres.2004.01.010.
  9. Li S-D, Chono S & Huang L (2008). Efficient Oncogene Silencing and Metastasis Inhibition via Systemic Delivery of siRNA. Molecular Therapy, 16(5), 942-946. doi: 10.1038/mt.2008.51.
  10. Suzuki, K, Ishida T, Yamagishi M, Ahlenstiel C, Swaminathan S, et al. (2011). Transcriptional gene silencing of HIV-1 through promoter targeted RNA is highly specific. RNA Biology, 8(6), 1035-1046. doi: 10.4161/rna.8.6.16264.
  11. Mitsuyasu RT, Merigan TC, Carr A, Zack JA, Winters MA, et al. (2009). Phase 2 gene therapy trial of an anti-HIV ribozyme in autologous CD34+ cells. Nature Medicine, 15, 285-292. doi: 10.1038/nm.1932.

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