Can we cure HIV already? It’s a tough question and one that ViiV Healthcare’s Max Lataillade would love to have a concrete answer for.
But it depends how you define cure. A functional cure means suppressing the virus to a point where a patient can mostly live normally, but the virus is not gone. It lies dormant deep in the cells and is still capable of replicating. A sterilizing cure, on the other hand, means the virus is gone and it’s not coming back. Unfortunately, we’re not there yet.
“Our idea of a functional cure is to have the patients stay off intervention for a certain amount of time, or finite amount of time, and you’re still monitoring the virus,” Lataillade said during Fierce Biotech’s Next Gen event. “A sterilizing cure would be where we would probably use the word ‘cure’ by saying that we cured the virus and we eradicated the virus.
“I will say that now, where we are, is really working on functional cure.”
One thing is for sure: The standard of care for HIV patients has advanced immensely in the past decade, and a lot of that is thanks to Lataillade’s team at the GSK-Pfizer HIV-focused pharmaceutical company. Lataillade, who is still a practicing physician and volunteer at the West Haven VA HIV clinic in Connecticut, serves as vice president and head of global research strategy for ViiV Healthcare.
The big breakthroughs in HIV include bringing down treatment regimens from three drugs to two, improving on safety and tolerability, advancing long-acting treatments and more.
“It was kind of a strategy that could have backfired on us,” Lataillade said of moving treatment regimens from three drugs to two. He remembers in his training being told that the minimum was three, with two different mechanisms of action required to make an impact on the virus. But it ultimately worked, and ViiV was able to roll out double treatment regimens including Juluca, a combination of dolutegravir and rilpivirine, and Dovato, which combines dolutegravir and lamivudine. These therapies provide patients with different options and can help them find a tolerability profile that works for them.
“We always say to patients, why do you need to take more drugs when you don’t have to?” Lataillade said.
The next frontier is creating even longer-acting medicines with dosing spaced further apart. On this front, ViiV recently won approval for Cabenuva, a combination of cabotegravir and rilpivirine that is administered monthly or every other month.
Lataillade and his team are also developing a nucleoside reverse transcriptase translocation inhibitor, while other efforts are underway in PrEP, or preexposure prophylaxis, which prevents infection for those at risk.
ViiV doesn’t want to leave any HIV patients out, so the company is working on options for a small population with disease-resistant HIV as well, Lataillade said.
Another piece of the HIV puzzle that has yet to be solved—despite a serious effort across the pharmaceutical and biotech industry—is vaccines. Lataillade said the HIV research scene has benefited from renewed energy thanks to the swift work done to create vaccines for the COVID-19 pandemic.
While Lataillade couldn’t speak to ViiV’s specific plans in this research area, he did say that HIV patients are unlikely to have a quick breakthrough like COVID, even though mRNA has emerged as a potentially promising modality. Moderna has multiple HIV vaccines in the works, but it’s still far out from having definitive data.
“You can see how hard this is going to be,” he said, pointing to some of the long-held challenges in HIV drug development. He welcomed more data on mRNA vaccines to come but said “this is going to be a daunting task.”
Mostly because with preventive or therapeutic vaccines and therapeutics—however you’re treating HIV—the medicine has to flush out dormant virus that so far has evaded treatment and allowed the virus to continue to replicate.
As a practicing physician, Lataillade says the “hot topics” he hears about in the clinic are even more long-lasting treatments and improving patients’ immune systems so they work just like anyone else’s. Patients want to stretch out their treatments as long as possible and have self-administered options, as well.