So Pathogenic or So What?—A Brief Overview of SIV Pathogenesis with an Emphasis on Cure Research

HIV infection requires lifelong antiretroviral therapy (ART) to control disease progression. Although ART has greatly extended the life expectancy of persons living with HIV (PWH), PWH nonetheless suffer from an increase in AIDS-related and non-AIDS related comorbidities resulting from HIV pathogenesis. Thus, an HIV cure is imperative to improve the quality of life of PWH. In this review, we discuss the origins of various SIV strains utilized in cure and comorbidity research as well as their respective animal species used. We briefly detail the life cycle of HIV and describe the pathogenesis of HIV/SIV and the integral role of chronic immune activation and inflammation on disease progression and comorbidities, with comparisons between pathogenic infections and nonpathogenic infections that occur in natural hosts of SIVs. We further discuss the various HIV cure strategies being explored with an emphasis on immunological therapies and “shock and kill”.

Ethical and practical considerations for HIV cure-related research at the end-of-life: a qualitative interview and focus group study in the United States

Background One of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it. Methods We conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable. Results All four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL. Conclusion Because of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings.

Impure Hopes

The experiment in China that produced the world's first babies with “edited” DNA comes out of an international research program aimed at producing an HIV cure. An atmosphere of secrecy surrounded this experiment at the edge of the law. Volunteers who signed up for the experiment were HIV-positive tonzghi—gay and bisexual “comrades” already living with closely guarded secrets and conflicted desires. Impure hopes—a mix of heterosexual dreams about reproductive futurity and biotech speculation about an HIV cure—drove the research forward. Volunteers were caught between dreamworlds, harboring hopes that were not entirely their own. The story of these patients is tangled up with CRISPR, a fast and cheap tool for manipulating DNA that contains tantalizing promises of medical breakthroughs for innovators and investors. Speculation in the innovation economy produced an earlier gene-editing experiment in the United States that brought HIV-positive veterans of ACT UP together with biotechnology entrepreneurs. After achieving promising results, a fickle market pushed gene-editing enterprises away from HIV cure research. Building on earlier work about impure science, this article makes an argument against purity to consider the contours of hope in ethically compromised times. Hope demands ongoing articulation work. As powerful political and economic forces threaten to steal queer hopes or simply capitalize on them, it is important to make our own ethical, political, and discursive cuts—to selectively renew some articulations while breaking other connections.