El profesor John Frater, de la Universidad de Oxford, expondrá en la sesión plenaria del martes 24 de noviembre un tema de gran interés y actualidad en el abordaje del VIH: ¿Qué nos susurran los ensayos con anticuerpos monoclonales sobre la remisión del VIH? En esta entrevista nos avanza algunas claves de su intervención.
Monoclonal antibodies have become one of the most promising areas of HIV research. What current evidence do you find most encouraging?
There is evidence from animal models and increasingly from human clinical trials that shows bNAbs can suppress HIV in the absence of ART in many people. The long-term potential action is very encouraging and there are also interesting early findings on the impact of the reservoir
What lessons are recent trials teaching us about viral dynamics and the immune response during treatment interruptions?
Treatment interruptions need to be managed very carefully but trials like RIO, eCLEAR, AbVax as well as some of the earlier work into post treatment controllers (like VISCONTI) raise interesting questions about which immune responses are most important to provide control – I don’t think we know the answers yet, and it may vary from person to person.
Do you think antibodies could have a stable role in functional cure strategies, or will their usefulness be more often combined with other approaches?
At the moment it would seem likely that any future cure strategy would include an immunotherapy component, and bNAbs combined with other agents are a plausible way forward, but it is not yet clear what these other approaches would be.
What are the main obstacles—scientific and clinical—to translating these findings into clinical practice?
This is dependent on the goal. We are moving in the direction of long-acting therapies and bNAbs could be a component of this. Pre-existing resistance in some people is an issue, and we likely need a new generation of bNAbS with better resistance profiles. Also, we still don’t fully understand how best to target the ‘reservoir’ but there is progress in this direction
How do you envision the integration of monoclonal antibodies into the future of HIV therapeutic management?
An effective, long-acting bNAb combination with a high barrier to resistance that could be given subcutaneously would be a valuable component of future therapy
From your experience in translational research, what lessons can be applied to other persistent viruses or chronic infections?
Each infection has its own unique issues and problems. A cure for Hepatitis B feels achievable and lessons from HIV – particularly the role of monoclonals – could help inform this