

Can AIDS be cured? - ezhil
http://www.newyorker.com/magazine/2014/12/22/can-aids-cured

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NiftyFifty
As a business model, why would you want to? The Ebola startup project didn't
get enough funding, so maintain the status quote. I say this with a sarcastic
tone (not being a troll here) I know, but effectively in a high-brow way the
article is saying the same thing IMH(umble)O.

~~~
omonra
1\. I know it's HN and all - but not everything has a _business model_. Ie I'd
say most important things in life are not cash-flow positive.

That's why developed (ie they're actually more developed - not just called
that) countries have a massive income redistribution in place to pay for
things that society needs (which lack a business model-y)

2\. the H in IMHO already means humble, there's no need to explain it :)

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tommorris
The article is interesting in terms of the fairly clever science but doesn't
point out the really amazing success of the PrEP trials. A variety of PrEP
trials have been taking place including the use of oral
emtricitabine/tenofovir (Truvada) tablets in a Western context (the PROUD and
iPrEx trials) and the CAPRISA 004 pericotal tenofovir gel trial in South
Africa.

The basic idea is this: using antiretrovirals as a preventative strategy. Take
one of the current combination HIV antiretrovirals (emtricitabine/tenofovir,
for instance) and administer it to patients who are at risk of getting HIV
(drug users, men who frequently have sex with men without condoms, people with
HIV positive partners).

The trials have been really successful. Adherence has been high. Side effects
have been low and controllable. Those on PrEP combined with a frequent testing
regime don't show signs of increased risk behaviour.

Because of the success of the trials, the WHO and the CDC are now recommending
that people in high-risk groups start taking a daily PrEP - and in the US,
plenty of doctors are now prescribing it for some of their high-risk patients.

Here's where it gets more interesting: the patents on Truvada, the
emtricitabine/tenofovir combo tablet, expire in 2016. Currently Truvada as
PrEP is an expensive proposition: in the US costing between $8,000 and $14,000
according to government figures. Low-income users of PrEP can get financial
subsidy from Gilead Sciences, the manufacturer of Truvada—Gilead don't
consider Truvada as PrEP to be a major financial gain for them so they are
providing subsidies in the US for PR reasons.

Countries with national healthcare systems are probably going to try and hold
off for long enough for Truvada as PrEP to go out of patent and then wait for
generics to come on the market.

That's when things get interesting. Currently, $8-$14k for a preventative is
too much even for rich countries to consider. It wouldn't pass the United
Kingdom's NICE process on cost-benefit grounds. But imagine if it cost a few
hundred dollars a year rather than a few thousand. Then the cost-benefit
analysis becomes a lot easier. In the UK, we currently pay around £300,000 to
treat an HIV positive patient over the course of their lifetime. A few hundred
dollars a year for those most at risk as a preventative cuts a lot of
healthcare costs.

Imagine the scenario: in the West, anyone who wants to get on PrEP would be
able to do so with minimal fuss—it'd be cheap enough that reasonably well-off
people could pay out of pocket, and it'd be covered by insurance and national
health coverage. It becomes as routine for the younger gay male population as
the contraceptive pill became with women. This provides the sexually
responsible a second line of defence, and the less sexually responsible a
pretty effective (90%+, if the iPrEx study is to be believed) first line of
defence. It's backed up by a routine testing and education regimen that
catches infections early to prevent spread. The challenge is how to roll it
out cheaply in Africa: finding a way to do bulk production of the drugs and
ensure they are being taken responsibly. The hard bit there isn't making the
pills but building the public health infrastructure. Still cheaper than the
economic costs of mass HIV infection though.

PrEP isn't a vaccine but it might end up functioning like one: reducing the
transmission rate in affected communities over the long run means less people
needing treatment and decreasing the overall risk of infection. And come 2016,
once the patents are gone, it'll be cheap. There's lots of people wringing
their hands about PrEP mostly for dumb moralistic reasons but it looks like
the first major innovation in HIV that might actually have a shot at working.

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zackmorris
I wish I could have posted this question earlier, but, if anyone in the know
is reading this, is there a newsgroup for AIDS or a site like
stackoverflow.com for medicine?

It hit me after reading this article that perhaps researchers could take a
step back and try to look at AIDS as a really hard math problem. That way they
could take a higher level view and be able to apply mathematical
transformations without getting lost in all the low-level biology and
chemistry.

So for example, here are some rules off the top of my head, if we use A for
AIDS, C for cells, I for immune system cells, T for time, P for protein, D for
drug, R for the rate of mutation, etc:

1\. Once A1 is within C1, it can’t be removed

2\. C1 expires after some duration T1

3\. A1 is invisible to I1 until P1 binds to A1

4\. P1 can be delivered to the body by D1

5\. P1 can be produced by the body in response to D2

6\. A1 mutates into A2 at rate R1

...

After applying a solver: Dn triggers immune system response that create P1,
P2..Pn which bind to A1, A2…An and keep An from leaving Cn for T years.

I don’t know what the form of these rules would be or how many there would be.
But if they were rearranged into a big matrix in a language like Prolog, then
computer simulations could be run that might reveal how to administer some
drug that triggers a response that creates something that interacts with the
AIDS virus and weakens it or makes it visible to the immune system. Maybe that
drug could be a lot cheaper than the current antiviral drugs. Or maybe it
could even be a one-time dose that causes the body to make that certain
something from then on, working at least until the virus mutates.

I did a quick google search of “protein that binds to AIDS virus” and found
these:

[http://en.wikipedia.org/wiki/Envelope_glycoprotein_GP120](http://en.wikipedia.org/wiki/Envelope_glycoprotein_GP120)

[http://vir.sgmjournals.org/content/86/11/3097.full](http://vir.sgmjournals.org/content/86/11/3097.full)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC191382/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC191382/)

[http://www.pnas.org/content/111/26/E2676.abstract](http://www.pnas.org/content/111/26/E2676.abstract)

They look like mumbo jumbo to me but some things jumped out, like this quote
from the second link:

“Native dodecameric SP-D bound to HIV gp120 more strongly than native trimeric
SP-D. Since one common polymorphic form of SP-D is predominantly expressed as
trimers and associated with lower blood levels, these individuals may have
less effective innate defence [sic] against HIV.”

This is probably old news to experts but it was certainly news to me that
things like this are already present in the body and come in different forms
in different people and have a lot to do with an individual’s susceptibility.
I think the web could be used to bring non-medical folks “up to speed” on
certain key insights like this. Big data APIs like IBM’s Watson could find the
hidden relationships by looking not just at links but at the semantics of the
pages.

I’m just saying that everyone could use a little help from outside their
chosen field, and building these rulesets and crunching them in big
distributed computer networks is really easy for computer scientists (and
hackers, honestly). We are used to hammering on a problem until the solution
is found, and we are compelled to keep after it, especially if the solution is
elusive. If we had a standard notation to go between biology and mathematics,
then it would open up a lot of possibilities for kind of “open sourcing”
medical research.

I realize this is probably already a work in progress somewhere, but if this
isn’t a mainstream thing like SETI@home, then it doesn’t quite exist yet, you
know?

