Speed ​​may be defeated in the next five years. Valaciclovir will help defeat HIV infection Subscribe to the page

The well-known drug valacyclovir (aka Valtrex), used for the treatment and prevention of relapses of diseases caused by the herpes simplex virus, has proven to be an effective remedy in the fight against HIV infection. The discovery was made by accident - during the treatment of this very herpes.

About 90% of the world's population is infected with the herpes simplex virus, and the vast majority do not even suspect it. Scientists have identified 8 types of herpes virus. Herpes simplex virus type I (HSV-1) is the cause of lip blisters. Herpes simplex type II HSV-2 causes a rash on the genitals. This genital herpes virus HSV-2 is fought with the drug valacyclovir, or Valtrex.

However, as it turned out, in one of the clinics in Peru, treatment of genital herpes HSV-2 with valacyclovir in HIV-infected patients (that is, patients with AIDS) unexpectedly produced a therapeutic effect in relation to AIDS itself: in those infected with HIV infection, the concentration of HIV RNA in blood plasma.
Then American doctors took up this issue closely. Laboratory tests of this fact were carried out, and it turned out that yes, the drug suppresses the replication of the human immunodeficiency virus! Clinical studies were carried out over six months in the USA and Peru. In addition to patients with herpes, 18 more patients with HIV-1, but seronegative for HSV-2 - that is, not infected with genital herpes, were recruited to participate in the experiment. They were divided into 2 groups and for 12 weeks, one group received valacyclovir (500 mg twice a day), and the second received a placebo, that is, dummy tablets made from ordinary non-medicinal but harmless chalk. Then, after a two-week break, the groups switched places for the next 12 weeks.
Moreover, for the purity of the experiment, during the entire six-month study, neither patients nor doctors knew who took the active drug and who took the placebo. The results were very encouraging: those HIV-positive patients who received valacyclovir showed clear progress in reducing the AIDS viral infection . But when they were given placebo pills, AIDS got worse again.
Thus, the suppression of human immunodeficiency viruses by the “antiherpes” valacyclovir has been unequivocally proven.
The results of the clinical studies were published in the journal Clinical Infectious Diseases.
“The drug can be safely used in patients with HIV infection who are highly resistant to other antiretroviral drugs. Valaciclovir is well tolerated and has no side effects,” comments Professor Mikhail Lederman.
Professor Benigno Rodriguez says valacyclovir reduces viral load because when it is activated inside HIV-infected cells, the virus stops reproducing. Professor Lederman added: "Our clinical study shows that acyclovir directly blocks HIV replication. The anti-HIV activity of valacyclovir is independent of blocking inflammation caused by the herpes simplex virus."
Thus, a new direction in the treatment of AIDS has been opened, and effective anti-HIV drugs will soon be developed based on the molecular structure of valacyclovir.

AIDS patients still have only one hope - antiretroviral therapy, which is based on drugs that prevent the replication of HIV. The genome of this virus is written in RNA, so after entering the cell, it uses the enzyme reverse transcriptase to make a copy of the DNA on the template of its own RNA. Then, from this DNA, the cell’s own proteins begin to stamp viral RNA. If, say, the reverse transcriptase of a virus is suppressed, then it will not be able to reproduce.

However, even cocktails of antiretroviral drugs only help to transfer the disease from the acute phase to the chronic phase. Such therapy cannot do anything with a virus that floats in the blood or is dormant in a cell. Therefore, researchers are looking for a way to get rid of the virus itself, and not just suppress its ability to reproduce. (By the way, conventional anti-HIV therapy theoretically allows you to get rid of the virus, but only under special conditions, and such cases, alas, are rare.)

But when it comes to completely eliminating HIV, everyone agrees that there is no better tool than antibodies. On the one hand, everything is simple here, it is enough to find immunoglobulins that would recognize the protein of the viral envelope, bind to it and signal to the killer immune cells that this complex needs to be destroyed. The problem, however, is that HIV has enormous variability, and antibodies usually catch only a certain fraction of viral particles, because the same protein is endowed with a number of differences due to which antibodies do not see it.

But our immunity is still able to cope with such a diversity of the virus, creating broad-spectrum antibodies. Scientists discovered in 2010 that the immune system can produce immunoglobulins that recognize more than 90% of HIV varieties, and this discovery, of course, gave everyone hope that AIDS was about to fall. But over time, it turned out that such antibodies arise rarely and after a huge period of time, moreover, exclusively in response to a real infection - that is, it will not be possible to provoke their synthesis using a vaccine from a killed pathogen.

Meanwhile, scientists continued to work with similar antibodies. And not so long ago, it was possible to discover universal antibodies, which appear much earlier and look simpler than those observed before - however, their universality turned out to be lower. But is it necessary to force the immune system itself to produce such antibodies? As experiments by two research groups - from the Beth Israel Deaconess Medical Center and the National Institute of Allergy and Infectious Diseases (both in the USA) have shown - broad-spectrum immunoglobulins, simply injected into the blood, effectively lower the level of HIV.

The groups of Dan Baruch and Malcolm Martin experimented with monkeys: rhesus monkeys were infected with hybrid monkey-human HIV, which multiplied in macaques, but looked similar to the human virus. The weapon against it was broad-spectrum antibodies obtained from AIDS patients.

Baruch and his colleagues used a cocktail of three types of antibodies, and within a week the level of the virus dropped so much that it was undetectable. A similar result was observed when only one type of immunoglobulin was used instead of a mixture of immunoglobulins. After the level of such antibodies in the blood began to decline, the concentration of the virus rose again, but in some monkeys it still remained indistinguishably low even without additional doses of antibodies.

The work of Martin and his colleagues deals with approximately the same thing, only here the researchers used other types of antibodies against HIV. Again, the concentration of the virus dropped within seven days in the macaques to an undetectable (once again: undetectable!) level and remained there for 56 days, until the antibodies themselves began to disappear. Then everything depended on how much virus the monkeys had initially: if there was little, then after the antibodies disappeared, the virus remained under the control of the animals’ own immunity, but if there was initially a lot of it, then the level began to increase.

As the researchers emphasize, the virus disappeared both from the blood and from other tissues, and it did not develop any resistance to the administered antibodies. (There was, however, one exception: when only one antibody was administered in the second study, and the test subject was a macaque with 3 years of experience cohabiting with the virus, it developed a resistant viral strain.)

In two cases, scientists did not treat the virus with human antibodies for very long because they were afraid that the monkeys' immune systems would begin to rebel against foreign immune proteins, and perhaps this was the reason that in most cases the virus was restored. That is, it is not yet clear whether this effect can be made “long-lasting.” All this will become clear only after clinical trials; As for the results described above, the enthusiasm of the researchers can be understood - for the first time in a living organism it was possible to reduce the level of viremia so much.

Vaccinations can cause autism, serious illnesses are treated with homeopathy, HIV inevitably leads to death, GMOs are dangerous to eat - is this true? It is important for everyone to know the correct answer, because our life and health depend on it. In her new book, scientific journalist Asya Kazantseva explains: to figure out whether this or that statement is reliable, you don’t have to be a narrow specialist. The main thing is to learn to analyze publicly available information. And then, if “someone is wrong on the Internet,” you will definitely notice it.

Asya Kazantseva’s first book “Who would have thought? How the Brain Makes Us Do Stupid Things" was highly appreciated by scientists and ordinary readers - it has remained a bestseller for several years. In 2014, the book was awarded the Enlightener Prize. In everything that Asya does, be it popular science lectures, articles or books, her rare ability to talk about complex things in an accessible and captivating way is evident, without simplifying or changing the scientific approach.

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When will we finally defeat HIV?

It's not clear yet. Unlikely in the next 10 years. But there is progress.

The most famous of the impressive stories is that of the Berlin patient, Timothy Ray Brown. This lucky man was simultaneously infected with HIV and had leukemia. He required a bone marrow transplant. His attending physician, Gero Hütter, about to begin the routine procedure of finding a compatible donor, remembered a university lecture that some people have a mutation in the CCR 5 coreceptor (which, along with CD 4, is used by the virus to penetrate the cell) and such people are much less likely to susceptible to HIV. In the registry of potential bone marrow donors, there were 80 people whose cells were suitable for transplantation to Timothy Brown (a fantastically successful result, by the way). Dr. Hütter began researching the gene CCR 5 from all these people, and on the 62nd attempt his hopes were realized. Timothy Brown's new lymphocytes have a pleasant additional property: the human immunodeficiency virus practically cannot penetrate them. In 2009, 20 months after the operation, Dr. Gero Hütter reported that, despite the lack of antiretroviral therapy, HIV still could not be detected in the blood, bone marrow, or intestinal mucosa. In 2011, the doctor confirmed that signs of virus replication could still not be detected. In 2013, unfortunate Timothy Brown was meticulously examined in six laboratories and literally from all sides - biopsies, punctures, colonoscopies, a bunch of blood tests, all conceivable and inconceivable ways of searching for the virus in all biological materials. Under such conditions, two laboratories were able to detect traces of the virus’s RNA in the blood plasma, and one detected its DNA in the rectum - however, given the lack of such data in other laboratories, a false positive result cannot be completely ruled out. In any case, the virus still cannot be detected either in blood cells, or in lymph nodes, or in the cerebrospinal fluid, or in the mucous membrane of the small intestine (where a lot of lymphocytes always hang out, so the place to look is quite logical). And in 2015, Timothy Brown himself published an article about his experience: how he fell ill, how he accidentally chose the hospital closest to his home, where he met Gero Hütter, how the treatment went, why he decided not to hide his real name and communicate with the press. “I don’t want to be the only person in the world cured of HIV,” Timothy writes. “I want other HIV-positive patients to join my club!” Today, he has moved from Germany back to his homeland, the United States, and founded a foundation named after himself there to finance research into vaccines and ways to completely cure HIV.

Of course, the treatment method used for Timothy Brown is not suitable for ordinary patients: the process of bone marrow replacement is incomparably more dangerous than HIV infection. This example simply illustrates that some people have biological characteristics that make them less susceptible to developing the disease. Mutation in the gene CCR 5 is only one of these features, but in general doctors identify a whole group of “non-progressors” - people who, after being infected with HIV, maintain a normal concentration of CD 4 + lymphocytes for years without antiretroviral therapy. Depending on the criteria of what is “years” and what is “normal concentration”, estimates of the number of these lucky ones in different publications vary within very wide limits; the author of the most clear review I found suggests that such people make up 2–5% of all HIV-infected people. The reasons for this resistance may vary. Someone was simply lucky to become infected with a weakened, unsuccessfully mutated version of HIV. For some, cytotoxic CD 8 + lymphocytes work especially well - they quickly and mercilessly find and destroy every new infected cell. Some people produce a particularly large amount of the antiviral enzyme APOBEC 3 G, which prevents the integration of viral DNA into the host genome. Someone has a lucky combination MHC-genes, which makes it possible to attract especially close attention of the immune system to the new virus. Some people have developed particularly successful antibodies. And so on and so forth - there's a ton of clever and beautiful molecular biology out there. It is important that these mechanisms need to be studied because they are the key to new drugs against HIV. So far, the only such new drug that has entered clinical practice is maraviroc, which binds to the CCR 5 coreceptor, preventing the virus from doing the same and, accordingly, penetrating the cell.

But in general there are a lot of promising approaches. New regimens of antiretroviral therapy are being explored that focus on intensive treatment of the disease soon after infection - there is anecdotal evidence that this may, in some cases, allow the infection to be suppressed before it takes hold of the body. A search is underway for drugs that could stimulate (!) the synthesis of new viral particles: when the DNA of the virus is integrated into the genome and is inactive, this reservoir of infection is almost impossible to detect, but the immune system fights against cells that intensively produce the virus. The first trials of gene therapy have already been carried out - several people were injected with their own CD 4 + lymphocytes with an altered CCR 5 coreceptor (the principle is the same as in the Berlin patient, only without a bone marrow transplant), and the results were quite encouraging; at least such cells survive normally in the bloodstream and are not susceptible to infection by HIV. Another possible approach is to search for good, successful variants of antibodies against the virus and then administer them to patients. And the most interesting story, although still far from clinical practice, is the use of a new gene editing method, CRISPR/Cas 9 (I will talk about it in the chapter on GMOs), in order to simply take and cut viral DNA from human genome. It has already been shown that this can actually be done in cell culture. All that remains is to figure out how to do the same with a real patient.

The latest trendy topic to talk about in connection with HIV is the prospects for a vaccine. Frankly speaking, the prospects are vague. The universal principle of vaccination - “introduce a weakened pathogen or its fragments” - does not work well here. The pathogen cannot be introduced at all, it is too dangerous. The body may develop antibodies to its fragments (and even then, not all vaccines can achieve such a result) - but these will be antibodies only to the specific variety of the virus that was used to create the vaccine. As soon as a person is exposed to some other strain, he is vulnerable again. The story is similar with the flu, against which a new vaccine therefore has to be created every year. But HIV is even more diverse than the flu, and, fortunately, it does not occur so often that an attempt to develop (and inject every person!) vaccines against all existing strains would be cost-effective.

We have to come up with more cunning approaches. For example, three vaccines are currently being developed in Russia. At the Moscow Institute of Immunology they made “Vichrepol”, which contains the most conservative, rarely changing HIV proteins (obtained by genetic engineering methods). The St. Petersburg Biomedical Center has the DNA-4 vaccine - four HIV genes in one plasmid. Proteins are built in human cells based on genes, antibodies are formed to proteins, and an immune response is obtained. The vaccine created at the Novosibirsk State Research Center of Virology and Immunology “Vector” is called “CombiHIVvac”. It contains a complex and beautiful artificial protein TBI, which includes fragments of HIV antigens, spatially oriented in such a way that it is convenient for B-lymphocytes and T-lymphocytes to get acquainted with them. But none of these drugs have yet undergone phase 2 or 3 clinical trials to evaluate their effectiveness. And it is at this moment that all hopes are usually destroyed. Sometimes it turns out that a new vaccine, the developers of which threatened to save humanity, not only does not reduce, but increases the risk of infection.

Testing the effectiveness of an HIV vaccine is a separate issue. You need to recruit a very large group of healthy people, give half the vaccine, half the placebo, and then wait for several years to see which of them will become infected with HIV and which will not. People, in general, are rather frivolous creatures, they do not like to use condoms, and in any sufficiently large group that is observed for a sufficiently long time, there will definitely be infected people. All that remains is to compare how many are infected in the group that received the vaccine and how many in the group that received the placebo.

The most successful HIV vaccine to date reduces the likelihood of infection by a third. This is better than nothing, but, alas, still not enough to launch mass vaccination. It is based on repeated administration of two drugs. One of them is a viral vector that delivers three HIV genes into cells. The second is the viral glycoprotein gp120 created using genetic engineering (a mushroom cap, if you still remember my attempts to describe the life cycle of the virus using artistic images). 16 thousand people took part in the tests. Half of them received injections of the real drug, half - a placebo. Over three and a half years of observation, 56 people in the group that received the real vaccine and 76 people in the group that received the placebo became infected with HIV. There was no difference in the number of viral particles in the blood of those who did become infected between the real vaccine and placebo groups.

One should not at all conclude from this that developing a vaccine against HIV is a hopeless endeavor. Researchers are actively working, the mechanisms of the immune response are becoming increasingly clear, many parallel directions are developing, all of them contribute to the body of knowledge. There may not be a dramatic breakthrough in the development of a vaccine against HIV in the coming years, but the effectiveness of the drugs will become increasingly higher and sooner or later will reach a level at which vaccination already becomes meaningful. Just now, at the moment when I had already finished the chapter on HIV (on a rather pessimistic note) and described in the fourth chapter the influence of acupuncture on my work history, scientific journalist Alexey Torgashev drew my attention (and the attention of the public) to three recent articles, , , dedicated to discussing the issue of how to vaccinate people (more precisely, animals for now) so that they produce broad-spectrum antibodies capable of neutralizing a large number of different strains of the virus.

Here we need to remember again how antibodies are produced - I wrote about this in the chapter on vaccinations. At first, a B lymphocyte binds to an antigen by chance, simply because its receptor is more or less suitable. Then, after receiving a permissive signal from the T-lymphocyte, the B-lymphocyte begins to multiply and mutate in order to produce different variants of antibodies, from which the most suitable ones can be selected. And in order to produce not just any antibodies to HIV at all, but antibodies of a certain structure aimed at a specific fragment of the virus, many, many specific mutations must occur, and all in a certain, given direction. That is, you must first introduce the first antigen in order to, in principle, provoke a series of mutations in the B lymphocytes that recognized it. Then introduce a second antigen so that among this new population of B-lymphocytes there is someone who binds specifically to it - and also begins to mutate for the purpose of even better binding. Then introduce another antigen to select suitable B-lymphocytes for selection specifically among these third-generation mutants. And so on until such antibodies appear that can effectively protect the patient from HIV.

With conventional vaccination, different people get different antibodies. Some catch the virus, relatively speaking, by the heel, others by the tails of their coats, and others by the ring finger. And here it is necessary that antibodies in all patients are formed in such a way that they can catch the virus specifically by the third button of the shirt. Moreover, if you introduce only shirt buttons at once, the immune system will most likely ignore them; they do not look very much like a big dangerous criminal. We must first introduce the shirt, and then reward those who got involved with the buttons in it, and then those who got involved with the third button. It sounds stupid, but there is an illusion of understanding (well, at least for me). It becomes clear that terribly complex and beautiful approaches are used in the fight against HIV, so, most likely, we will wait until humanity’s final victory over the virus. In the meantime, we should not be afraid of HIV-infected people, not think that they will die immediately or will not be able to work, and calmly be friends with them. When friendship comes to sex, use condoms. As, in fact, with any new partner.

Vadim Pokrovsky spoke about methods of HIV prevention and treatment

Vadim Pokrovsky

Moscow. November 26. website - Head of the Federal Scientific and Methodological Center for the Control and Prevention of HIV Infection Central Research Institute of Epidemiology of Rospotrebnadzor, Academician of the Russian Academy of Sciences Vadim Pokrovsky told Interfax correspondent Anna Sineva on the eve of World AIDS Day, celebrated on December 1, about methods of HIV prevention and treatment, statistics on infected people, center funding, promising research into a cure for HIV.

For many years, HIV was a disease with a death sentence. And, despite the fact that medicine has made great progress in recent years, many continue to consider this a fatal disease. How would you characterize this disease now?

HIV/AIDS was, and remains, fatal if a person infected with HIV does not receive modern treatment in time, and it is not always effective. The number of deaths from HIV/AIDS in the world is declining, but still about a million died from AIDS last year. And in Russia the number of deaths from AIDS is still growing. According to official data from Rosstat alone, 18,577 Russians died from HIV/AIDS in 2016, and 20,045 last year.

Another sad aspect: while it is impossible to completely cure HIV, it slowly continues its “dirty work”, so a person with HIV infection, even if he is on good treatment, quickly ages, becoming an old man 10 years earlier than a person without HIV .

- How many Russians now live with this diagnosis?

If we count from 1987, when the first case was identified, the number of registered HIV-infected Russians as of November 1 of this year was 1,306,109, of which 308,072 died, respectively, there were 998,037 living with HIV. But this number is growing by 200- 300 per day, and most likely the millionth Russian living with HIV has already been registered in one of the regions.

And by the end of 2018, we again expect 100 thousand new cases.

In 2015, the UN named Russia the epicenter of the global HIV epidemic. According to the organization, 80% of cases of infection in Eastern Europe occur in our country. How is the situation now, to what extent do our official statistics diverge from these data?

The epicenter is the area from which the epidemic spreads, and in Russia the epidemic began 10 years later than in the United States. It would be more correct to say that Russia is now the region where HIV is spreading most rapidly. Over the past three years, about 300 thousand HIV-infected Russians have been identified, 100 thousand cases a year. This is more than in the rest of Europe. For example, in Germany last year only 1,700 new cases were counted.

- Can the epidemic get out of control?

When I hear that “we have the HIV epidemic under control,” I remember the fable: “I caught a bear, but it won’t let me go.” We are monitoring how the epidemic is unfolding, but we cannot stop it yet. Populations in which HIV has long been spreading are already seriously affected: in some regions, more than 50% of drug users and 20% of men who have sex with men are diagnosed with HIV. The latter, in addition to homosexual men, also include those who have relationships with persons of both sexes (bisexuals), and there are many of them in Russia. Since HIV-infected drug addicts and bisexuals have sexual contact with people of the other sex (heterosexual), HIV spreads from them to the general population. According to preliminary data for the current year, 54.8% of newly registered HIV-positive people became infected through heterosexual contacts, 2.2% through homosexual contacts, and 42.5% through drug use. The percentage of people infected through homosexual contacts is small because there are few men who have sex with men in the population, but HIV spreads quickly in this group.

So far we have only managed to significantly reduce the probability of HIV transmission from an infected mother to a child; this no longer happens with a probability of 30-50%, but only 1-3%, but we still need to work here to get to zero.

Does the government pay enough attention to HIV prevention? Several years ago there was a public service announcement on this topic in the subway, but now there is practically no information anywhere. The state tried to fight HIV by introducing family values, not to mention the need to use condoms and disposable syringes, is this still the case?

Although the Ministry of Health in its instructions uses the term “barrier means of protection” instead of the word “condoms,” some positive shift is taking place. Condoms are being advertised on television again, so we cannot say that condoms are still neglected in the information field. Nevertheless, the main path to “fight AIDS” that the Ministry of Health has chosen is not to prevent infection, but to identify Russians already infected with HIV and enter their data into registers in order to someday begin treatment.

This is where our approaches with the Ministry of Health differ. In my opinion, it is necessary, first of all, to prevent infection, and not just to identify and treat it, especially since the Ministry of Health is not yet able to provide medications to all Russians who have HIV infection.

Our infection prevention programs are extremely weak. The Ministry of Health doesn’t even use the word “epidemic,” so why should people protect themselves? They explain: “we don’t want to spread panic among the population.” You might think that, having heard about this, people would run into the street shouting “Save yourself who can!” They are probably afraid that they will be scolded for “starting the epidemic.”

In my opinion, it is extremely harmful that people do not know about the threat of an African variant of the epidemic developing in our country, where HIV is spread predominantly through heterosexual means. In South Africa, in 1994, HIV was found only in white homosexuals, but now 20% of the population is infected, and half of all deaths are associated with AIDS. These figures are not so far away: now in Russia 1% of the adult population is diagnosed with HIV, and in some medium-sized cities - 4% of residents. The most affected group are Russians aged 30-40, that is, those who have already completed their studies and are working, and if they die, the working population will decrease.

- And according to unofficial estimates, how many HIV-infected people are there in Russia?

According to estimates, we have at least 1 million 300 thousand infected, that is, there are at least another 300 thousand, and maybe 500 thousand, not yet diagnosed cases.

- And what is the forecast?

The prognosis is still unfavorable, since the Ministry of Health does not want to acknowledge the epidemic and reports only on the successes achieved. But the successes are modest: last year, 340 thousand out of 900 thousand living with HIV received modern treatment, and this year - 412 thousand out of almost 1 million diagnosed. And despite this improvement, the number of deaths from HIV/AIDS is growing.

- And the rest?

For the rest, the Ministry of Health cannot yet provide medicines because there is not enough money. But there are more questions for the State Duma. We need to increase the budget, only in this case we will be able to close the gap and purchase medicines for everyone. In the meantime, the Ministry of Health is forced to buy medicines cheaper, but it is clear that they are not selling the best ones cheaply.

There are also bureaucratic obstacles. In our country, first, the passport data of HIV-positive people is entered into the register, then they only allocate money for the purchase of drugs for their treatment, and the purchase is made once a year. It may take quite a long time for a person to receive the medicine. And the global attitude is: to prevent the spread of HIV infection, it is necessary to begin treating all those infected with HIV immediately after detection. Most deaths are associated with late initiation of treatment.

At the end of 2016, a strategy was adopted to combat the spread of HIV infection in Russia until 2020. It stipulates that next year the number of infected people receiving antiviral therapy and registered at the dispensary should be 90%. How successfully is the strategy being implemented?

The goal declared by international organizations is to diagnose HIV infection in 90% of all those infected and provide treatment to 90% of those identified as HIV-infected, that is, it is necessary to give medicine to 81% of all those infected with HIV. Those receiving treatment are less likely to spread HIV, so they hope that such mass treatment will also stop the spread of HIV.

In our country, “all HIV-infected people” were replaced with “those registered at the dispensary,” and this is only 70% of the number of diagnosed patients. If you get a little more cunning and count only those whose passport details have been entered into the registers, then maybe you can reach 90%.

But approximately 30% of those diagnosed with HIV do not go to AIDS centers at all. These are not only drug addicts, but also those who do not want their data to be entered into any registers: what if they end up on some website? And this is a problem for us - how to bring them in and convince them to undergo treatment? From them and from those who do not yet know about their infection, HIV infection spreads.

Every year, 15-20% of those who start treatment quit it - they get bored and are worried about the side effects of therapy.

Thus, if the Ministry of Health announces that 90% are receiving treatment, make a mental adjustment - this is only 40-50% of the total number of HIV-positive Russians. This is not enough to stop the epidemic.

- How much does the number of infected people vary among different population groups?

Social groups are very different; as a percentage of the entire population, people with secondary specialized education are somewhat predominant. Probably because no prevention was carried out in their colleges. Among those visiting AIDS centers, almost 70% belong to the economically active part of the population, which is even more than in Russia as a whole. This is explained by age: the most people infected with HIV are in the group of 25-40 years old, the most able-bodied group. The highest percentage of infected people is among men 35-40 years old - more than 3% of them are registered as HIV-infected. Infected women of this age are 2%, but in the age group of 25-30 years the percentage of infected women is higher than men - 1%. This is explained by the growth of the heterosexual transmission route - women become infected from their older sexual partners. Many women think that you cannot get infected from your spouse. Meanwhile, it is believed that 30% of women in the world become infected from their husbands.

- What should women do to avoid becoming infected in this case?

The best option is to get tested for HIV together with the person with whom you want to have children, and before that, always use a condom. HIV infection is not an obstacle to marriage, but if you know that one of the spouses is infected, you can take measures to avoid becoming infected and to give birth to an uninfected child.

- How much money is needed and how much is the government currently spending on HIV treatment?

The federal Ministry of Health spends 21 billion rubles on medicines and about 10 billion more are spent by regional budgets. After all, HIV treatment is not only medicine, but also diagnostic kits for monitoring treatment, maintaining regional AIDS Centers, paying health workers, etc.

To fully provide medicines, about 50 billion rubles are needed - this is the price of a modern submarine, and the fight against the epidemic is also a matter of national security. The same amount must be spent on creating infrastructure, purchasing diagnostic equipment, hiring and training thousands of new doctors. Now AIDS centers are overwhelmed by the number of patients, doctors are overloaded.

HIV prevention efforts must also be well funded. In order to really bring the epidemic under control, it is no longer possible to spend less than 100 billion rubles.

- How much does it cost to provide medications to one patient?

The state now purchases drugs in the range from 10 thousand to 300 thousand rubles per year per person, depending on the complexity of the treatment of a particular patient. On average, about 60 thousand rubles for an annual course.

- If a person decides not to wait for funds to be allocated for him and buy medicine himself, will he spend the same amount?

You need to focus on 100-150 thousand a year. You can, of course, buy drugs for 20 thousand, but they are quite ancient, 20-30 years old. And the more modern the drug, the fewer side effects, the fewer pills you need to take at a time. But they are more expensive, and besides, our laws do not allow many new drugs to be purchased at public expense.

There are also drugs created in Russia that are not inferior in quality to imported ones, but they are few. Entrepreneurs prefer to take a simpler path and reproduce generics, that is, copies of foreign drugs. Few people invest in the development of new drugs, because the economic effect will only appear in a few years, and everyone wants to earn money immediately and without much effort.

The best scientists in the world are working on a cure for HIV, but so far it has not been found. Are there any promising developments today? And what do you think about the efforts to create a vaccine, how realistic is it?

For 30 years, it has not been possible to create a vaccine against HIV due to the fact that there are no cures, that is, acquired immunity, such as after measles, which one does not get sick with twice, is not developed during HIV infection. Therefore, scientists are now paying close attention to innate immunity. A small proportion of people in Northern Europe, about 1%, including those in Russia, are immune to HIV infection. Scientists are working to learn how to transfer this immunity from one person to another and artificially create immunity.

- Is this immunity a consequence of some change in genes?

Yes. And one successful experiment using this feature was conducted several years ago. An American patient with leukemia, a “blood cancer,” received a bone marrow transplant in Berlin from a person immune to HIV, and as a result, not only leukemia, but also HIV infection was cured. This "Berlin patient" is considered the only person cured of AIDS. But selecting donors for a bone marrow transplant is very difficult, so now a more promising idea is being developed - taking stem cells from the person himself, turning them into immune to the virus and introducing them back, both for treatment and prevention of infection. Our Central Research Institute of Epidemiology has already created experimental drugs of this type, but many years will pass before they are put into practice, since it is necessary to be sure that the method will not cause unpredictable consequences of interfering with the genome of cells.

- Do you think these developments will be successful and in what perspective?

I think that in a few years such healing techniques will appear. The question is rather how much they will cost, and how quickly they can be made cheap and accessible to everyone.

- Are there any countries comparable to Russia in terms of the number of infected people, in percentage terms?

The number of people infected with HIV in China and India is approximately the same as in Russia, but in percentage terms it is 10 times less. In the USA there are exactly the same number of people infected with HIV as we have, but there are also more people there.

To compare the situation, the characteristics of the epidemic and approaches to combating it are more important. Europe has long stopped the epidemic among drug users; the problem for them is homosexuals and bisexuals. And we have an epidemic among drug users in full swing, so the involvement of the rest of the population in the epidemic is inevitable if the spread of HIV in this group is not stopped. But it’s hard to work with them; address drug users on the radio, or don’t, there’s not much point. In Europe, special prevention methods were used, for example, “syringe exchange”, in which drug addicts are taught not to inject themselves with the same syringe, and to switch from intravenous drug administration to tablets. But we don’t approve of this - they say that if you distribute syringes, you are encouraging them to take drugs. They keep saying: “Let’s first cure them all of drug addiction.” Won't they die of AIDS before then? Therefore, Europeans decided to first protect drug addicts from contracting HIV, and at the same time attract them to treatment for drug addiction. But we only have arguments: drug addiction treatment is still ineffective and HIV prevention is not carried out.

Gay and bisexual men in Europe have proven difficult to work with because they are reluctant to use condoms. Especially since they know that AIDS is no longer so dangerous. In Europe, they are now being asked to start taking prophylactic antiretroviral drugs, this is called “pre-exposure prophylaxis.” In France, the state even provides medicines free of charge.

- But in Russia?

While we are starting the first studies, we know that some advanced citizens are already trying to use this method on their own.

- Is this method effective?

European specialists are delighted! But we cannot yet answer the question of whether it will be effective in our country. Moreover, the results of its use among drug addicts are not so brilliant. It is very important that the medications are taken constantly, regularly. Otherwise, it is possible that strains that are already resistant to these drugs will spread.

Is it possible that the HIV virus could mutate at some point in the future to become airborne? Is this more of a myth or does such a possibility exist?

The probability is about the same as the appearance of wings on an elephant. But even if this happens, the elephant will not fly: it’s too heavy...

- Is there a problem with the presence of counterfeit HIV drugs on the market?

I think that there are few counterfeit ones, but if you try to purchase them via the Internet, there is a possibility that they may sell drugs of lower quality or dummies. It is better to find pharmacies that sell officially.

- Is there a problem associated with psychics treating HIV?

Yes, but there are more problems associated with AIDS dissidents, those who believe that “HIV does not exist,” or that “HIV does not cause AIDS.” They all admit that “AIDS exists,” otherwise psychics and healers would have nothing to treat. And citizens often believe them, even people with higher education. Patients stop taking antiretroviral drugs, pay money for fictitious drugs, but after a few months they get worse. This happens very often and ends tragically.

- What are the side effects of medications?

All drugs have side effects, and in case of HIV infection you need to take several of them at once and for the rest of your life, accordingly, the side effects may increase. Medicines can affect the liver, cardiovascular, and nervous systems. Suicidal tendencies have been reported when taking certain medications. Therefore, attending physicians carefully monitor deviations associated with medications, and, if suspicion arises, drugs are replaced.

Some time ago there were fears that your center would lose funding. To what extent were these fears justified?

We are the only scientific institution in Russia that specifically deals with the problem of HIV/AIDS, epidemic surveillance, diagnosis, prevention and treatment. As a result of the administrative reform in 2004, we, together with the Central Research Institute of Epidemiology, of which we are a part, found ourselves in the system of Rospotrebnadzor, which finances us. Previously, the Ministry of Health provided us with medicines. Now there is no. This is motivated by the fact that Rospotrebnadzor institutions should not provide treatment, although we have all the permits and licenses. This concept appeared after I began to openly doubt the working methods of the Ministry of Health, although before that we had been treating patients for 30 years and developing new treatment methods for all institutions of the Ministry of Health.

As a result, we cannot help the Ministry of Health implement its plans for treatment coverage, and many of our patients had to move to other institutions where they were not very welcome: there are enough of their own patients.

We can treat patients, but not with the medicines that the Ministry of Health purchases. And we are researching new treatment methods, we are supported by Rospotrebnadzor. In January, we will begin testing a combination of only domestic drugs to make sure that we are completely independent from imports. Such studies had not been conducted before, and for some reason the Ministry of Health purchases very few of our medicines compared to imported ones. Participation in such tests is voluntary. Many HIV-positive people themselves want to do something to solve the problem, and we invite everyone.

- Are you currently experiencing problems with financing?

The Institute receives funding from Rospotrebnadzor and government orders for applied scientific research. Each employee of our center receives a researcher's salary. But there is no special funding. We collect data across the country and inform our government agencies about the real situation - how many have become infected with HIV, how many have died, what are the causes of infection, and we are developing diagnostic and treatment methods.

Unfortunately, in-depth scientific research into HIV infection is not yet specifically funded. If you want to do this kind of research, you have to apply for a research paper competition and compete with a thousand other projects. In my opinion, it is necessary to specifically allocate funding for scientific research in the field of AIDS, and to hold a competition among these studies. It is well known that research in the field of HIV/AIDS, although often unsuccessful, has significantly advanced the entire biological science. For example, developments in the creation of drugs for HIV were used to create drugs that completely cure the hepatitis C virus.

- Can you tell us about the human papillomavirus, is this disease dangerous and the vaccine against it?

There are many varieties of this virus. The most common ones cause papillomas on the skin and are transmitted through household contact. But there are also varieties that are sexually transmitted and can cause cancer, especially cancer of the cervix and glans penis. These tumors develop especially often in patients with HIV/AIDS due to weakened immunity. However, such cancer has “precursors”, condylomas and dysplasia, the diagnosis and treatment of which are quite effective. So far there are no drugs that completely cure the papilloma virus, but they are being developed, and I think that we will soon have such drugs.

To reduce the spread of dangerous varieties of this virus, a special vaccine can be used. The issue of vaccinating children is being discussed, since it is advisable to vaccinate before the onset of sexual activity. The side effects of vaccines are extremely exaggerated; dangerous drugs are simply not allowed for use.

Bone marrow transplantation from a donor with a rare genetic mutation has cured patients of human immunodeficiency virus.

Researchers reported three cases of curing patients from HIV infection. Until March 4, 2019, only one such case was known and was considered an exception or anomaly. The American who defeated the virus in 2007 is known in medical literature as the Berlin patient.

Nature magazine and the New York Times this week reported a second recovery, and on March 6, New Scientist described a third case. What they all have in common is a bone marrow transplant from a donor with the delta32 mutation in the CCR5 gene. Korrespondent.net tells whether all HIV+ people can be cured in this way.

Who defeated HIV

As of 2017, 37 million people worldwide are carriers of the human immunodeficiency virus. More than half of them are taking antiretroviral drugs and can lead a normal life.

Ukraine, like Russia and Belarus, occupies one of the first places in Europe in terms of HIV incidence - about 220 thousand infected.

The first person to be cured of HIV was American Timothy Brown. In Germany, 12 years ago, to treat leukemia, he was transplanted with hematopoietic stem cells from a donor with a fairly rare genetic mutation of the CCR5 gene - delta 32, which significantly reduces the likelihood of contracting HIV.

This gene encodes one of the receptor proteins on the surface of leukocytes to which HIV particles bind. A 32-nucleotide deletion in the CCR5 gene results in virions being unable to bind to the receptor, and the carrier of this mutation becomes immune to infection.

Since then, scientists have begun trying to repeat this achievement. But in each new case, the virus returned, often nine months after patients stopped taking antiretroviral drugs, and sometimes patients simply died.

The second person to recover was the London patient. The man, who asked to remain anonymous, contracted HIV in 2003, and in 2012 doctors discovered he had a type of blood cancer - Hodgkin's lymphoma.

This cancer can only be cured by a bone marrow transplant, which doctors at University College London, led by Professor Ravindra Gupta, performed in 2016 from an unrelated donor with the same rare mutation in the CCR5 gene.

Three years after the transplant and a year and a half later, after the patient stopped taking antiretroviral drugs, tests showed the absence of HIV in the man’s body. The patient is "functionally cured" and is "in remission," Gupta said.

The researchers caution that it is not entirely clear whether the presence of the corresponding genetic mutation in the donor is really the main factor.

The professor believes that the disappearance of the virus from the body could also be influenced by a complication that appeared in both patients. We are talking about a “graft versus host” reaction, when the transplanted material begins to attack the patient’s body.

On March 6, New Scientist reported on a third patient who may have been cured of HIV infection. Like the previous two patients, he received a bone marrow transplant from a donor with a mutation in the CCR5 gene.

The Düsseldorf patient was reported by researchers from Utrecht University, who, under the leadership of Annemarie Wensing, performed the transplant. Three months ago he stopped taking antiretroviral drugs, and still no viable virions have been found in him.

The researchers say they are following several more HIV patients who received bone marrow from a donor who carried a mutation in the CCR5 gene.

Scientists are monitoring the condition of 38 people with HIV infection who received bone marrow transplants, with six of them receiving transplants from donors without mutations. The London patient is number 36, the Dusseldorf patient is number 19.

Can HIV now be defeated?

Most people with the HIV-resistant mutation, called delta 32, are from Northern Europe. Specialists from IciStem have a database that contains information about approximately 22 thousand such donors.

However, experts say, this does not mean that humanity has learned to treat HIV and now everyone can be cured. Most believe that such treatment is not appropriate for all people living with HIV, even though not all are able to take antiviral drugs.

Hematopoietic stem cell transplantation is done only when absolutely necessary, since it is not only complex and expensive, but also a dangerous procedure that can result in death.

It is known that Brown, the first person to be cured, was given strong immunosuppressive drugs that are no longer used, and he suffered from serious complications for several months after the transplant. He was put into an induced coma, and at some point he almost died.

In addition, modern drugs allow people with the virus to differ little from healthy people.

Therefore, usually the patients who had the opportunity to be cured were those who developed lymphoma or leukemia, and these procedures were required for treatment and could not be done with other types of treatment. In this case, the donor must not only be histocompatible with the patient, but also have the necessary mutation.