Covid and HIV, two very different viruses, but against which the same weapon could be used: monoclonal antibodies
The HIV and Sars-CoV-2 viruses are different viruses, but they have in common the effect of accelerating the aging of the individual. The other point in common could come from the therapy of the future: the monoclonal antibodies they could in fact allow the eradication of both viruses.
It was discussed in Riccione during the ICAR Congress, an opportunity for the signing of the ICAR-IAPAC partnership agreement and for numerous initiatives to raise awareness on the issue of HIV and AIDS.
“A new monoclonal antibody being studied against HIV it attaches itself to CD4 cells, preventing the virus from entering the cell. This therapeutic approach has been studied for patients with a long history of antiretroviral therapy and in virological failure “, explains Prof. Anna Maria Cattelan, Director of the Infectious and Tropical Diseases Complex Operating Unit, Padua Hospital
Science at work on HIV and Sars-CoV-2: new solutions on the horizon after the extraordinary progress of recent months.
If for Covid vaccines have made it possible to reduce contagions and serious cases of disease, HIV for some years can be considered a chronic infection thanks to the advent of highly effective antiretroviral therapy that allows the control of viral replication and the consequent virological suppression, summarized in U=U, Undetectable=Untransmittable: HIV is not transmitted if the viremia of the HIV-positive partner is no longer detectable in the blood, thanks to the correct intake of effective antiretroviral therapy.
NEW THERAPEUTIC HORIZONS: THERAPEUTIC APPROACHES WITH MONOCLONAL ANTIBODIES
Monoclonal antibodies have become one of the most important pharmaceutical products also in the infectious field: the first monoclonal in this sense was used for the respiratory syncytial virus, then for the Clostridium difficile; studies have recently started e the first applications for HIV and Covid.
In the recent pandemic, this therapeutic approach has proved essential to prevent the disease triggered by Covid from degenerating into its most serious forms. In HIV, there is a monoclonal antibody, ibalizumab, which has passed phase 3 of testing, has already been approved by the FDA and EMA and is currently undergoing AIFA approval, and which will soon be available in our clinics. .
“This monoclonal antibody attaches itself to CD4 cells preventing the virus from entering the cell – explains the Prof. Anna Anna Cattelan – This therapeutic approach has been studied for patients with a long history of antiretroviral therapy and in virological failure. The data at 96 weeks of treatment indicate that even in multiple failures there was a virological response in 56% of cases; I would say an important result for future developments of the molecule. This is just the beginning, as these monoclonal antibodies could also be used in other settings, such as initial therapy and even HIV prevention. A study published this year in the New England Journal of Medicine in the prevention of HIV infection on more than 4 thousand subjects at high risk of infection, while not demonstrating efficacy in achieving this ambitious result, represented an important “proof of concept “, both for the development of future vaccines, and for the planning of further future studies that will have to include the simultaneous combination of several monoclonal antibodies capable of attacking the virus in a definitive way. Certainly a decade is opening up which will see the development of many advanced therapeutic strategies, certainly including gene therapy ”.
LONG COVID AND HIV AT THE BASIS OF EARLY Time.newsNG: THE IMPACT OF “GEROSCIENCE”
Among the many similarities that characterize Covid and HIV, there is research on the effect that both viruses have on the aging of the individual., understood as a condition of fragility with respect to the accumulation of deficits in the course of our life. “HIV is a refined model of accentuation and acceleration of the aging phenomenon – underlines Prof. Giovanni Guaraldi, infectious disease doctor at the University Hospital of Modena and Associate Professor at the local University. – In the last year, among the effects of the pandemic, we have also observed the Post Acute Covid Syndrome – PACS, often referred to simply Long Covid, also a phenomenon of aging of the person, as evidenced by the empirical confirmation in many patients who feel changed after Covid. HIV and PACS are united by this biological mechanism of acceleration of the phenomenon of aging with progression of frailty. A new science has emerged for some years on the subject of aging, the geroscience, according to which aging is a disease that should be treated with early diagnosis to favor targeted interventions through senolytic drugs, which can kill aging cells, and senomorphic drugs, which can modify cellular aging. Since HIV and Covid are two aging diseases, it is interesting to understand the geroscience approach to these diseases. However, HIV can already be considered a model in which geroscience is applied, given that antiretroviral therapy actually performs a senomorphic function ”.
HIV E SARS-COV-2 IN LABORATORY
Covid-19 has made infectious disease specialists relive the nightmare experienced in recent decades in the face of HIV. Yet, the two infections presented profound differences, which are reflected above all in the laboratory analyzes. “Sars-CoV-2 and HIV differ in the importance of the quantitative aspect, in the relationship between infection and contagiousness, in the monitoring of immunity, in the role of variants – underlines the Prof. Maria Rosaria Capobianchi. – In Covid, which is an acute infection, the importance of the quantitative aspects of the viral load has been considerably reduced, while it is crucial for the monitoring of HIV infection, a chronic infection “.
“If an HIV-infected patient achieves a quantitative reduction in viral load, they may no longer be contagious, as stated in the principle U=U; in Covid, on the other hand, there may be prolonged persistence of the viral genome in the respiratory tree, without however corresponding to a persistence of contagiousness. Also, it changes the concept of immunity: in HIV it is not a symptom of healing, but of an infection that lasts throughout life, while for Covid the presence of antibodies is the testimony of having encountered the virus and having overcome the infection. Antibodies are also a fundamental parameter for the evaluation of vaccine-induced protection, in model populations from which information on the duration and extent of protection can be drawn, so as to be able to design flexible and timely strategies for vaccination policies “.
“At the moment there are many tools available for measuring immunity, both natural and acquired thanks to the vaccine. However, the antibody levels that correspond to the protection status are not yet clear, and many laboratories are working on a comparison between the different methods. immunometric tests and the biological test that measures the ability to neutralize the infectivity of the virus. In fact this test, due to its complexity, cannot represent the routine standard, and for this reason, for the purposes of daily applications, more accessible and Furthermore, the most recent data also focus attention on cellular immunity, which appears to have a longer duration than antibody immunity. Cellular immunity also appears to be affected to a lesser extent by viral variability. Related to this, it must be said that son the Covid side there is great attention for the variants of the virus that could nullify the protection of immunity induced by the vaccine. In HIV, the experience gained in these 40 years has taught us that mutations are important in a different context, mainly linked to the efficacy of antiretroviral drugs “.
ICAR 2021: MANY INITIATIVES AND THE SIGNING OF THE ICAR-IAPAC AGREEMENT
Covid and HIV with all their implications, similarities and differences, are at the center of the 13th edition of the Congresso ICAR – Italian Conference on AIDS and Antiviral Research, in progress at the Palazzo dei Congressi in Riccione until Saturday 23 October. ICAR, organized under the aegis of SIMIT, Italian Society of Infectious and Tropical Diseases, of all the major scientific societies in the infectious and virological area and of the community world, is a point of reference for the scientific community on the subject of HIV-AIDS, Hepatitis, Sexually Transmitted and Viral Infections.
On the occasion of the Congress, Prof. Antonella d’Arminio Monforte (Fast-Track Cities delegate for Italy, as well as ICAR President) and Bertrand Audoin (Vice President, Strategic Partnerships, IAPAC International Association of Providers of AIDS Care, Paris) on October 23 will sign the ICAR-IAPAC partnership agreement. In the world, over 300 cities have joined the Fast-Track Cities Project, of which 8 in Italy (Bergamo, Brescia, Florence, Latina, Milan, Palermo, Sanremo, Turin) in order to commit to increasing responses in the fight AIDS, with a network of collaboration between public and private bodies, a sharing of good practices of action and monitoring, of the innovative ideas launched with the other Fast Track cities.