We’ve been nipping at this virus’ heels for decades. No matter how good the antiviral drugs get, until we can successfully rouse sleepy HIV from its hiding spots around the body, a cure will elude us. Perhaps this goal is getting within reach, though, as a small trial of a drug that’s already on the market is showing some early signs of success.
It’s called disulfiram, or Antabuse, and it’s actually purposed for something completely different: to treat alcoholism. If you drink booze while on this drug, you’ll experience a host of nasty, discouraging side effects like vomiting, palpitations and chest pain.
But a few years ago, a team of scientists started screening libraries of drugs to see if they could find any that could coax HIV out of hiding, or so-called latent reservoirs that escape both antiviral drugs and the scouts of the immune system, and disulfiram turned out to be a hit. It had already been long-approved by the FDA at this time, and it was known to be safe because doctors were already using it to treat both alcohol and cocaine addiction in HIV-positive patients.
It’s still not entirely clear how it works on HIV, but studies on cells in a dish showed it was indeed capable of “reactivating” latent HIV, basically stirring it into active replication. And once particles start being produced again, these can be sniffed out by the immune system or targeted drugs, leading to the depletion of these problematic pools of virus. This combined strategy is known as “kick and kill,” but even with many promising candidate drugs popping up, none have led to the long-awaited cure.
Even when disulfiram was put through its paces in a small trial back in 2012, it didn’t seem to be effective at tackling the latent reservoirs. They modestly shrank in size, but the increase in viral replication observed wasn’t statistically significant. But hope may be renewed, as a new study of 30 patients seems to support the notion that it is indeed capable of activating HIV replication in infected patients.
Published in The Lancet HIV, patients were already controlling their infections with antiviral drugs, but they were trialled with three different doses of disulfiram over just three days. Even this short-term regimen was found to boost the amount of viral genetic material found in patients, and no serious side effects were observed. Scientists will need to confirm that the observed effects are indeed due to reactivation of latent pools, but hopefully larger trials can be initiated soon to find out more. And if they find an effective “kill” drug to add to this “kick,” perhaps we could finally be headed towards a cure.
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