A major HIV researcher has challenged fellow scientists to question various perceptions about the virus and its treatment in hopes of spurring new avenues of research. Publishing his essay in Trends in Molecular Medicine, Jay A. Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California, San Francisco, posed a series of questions pertaining to research into cures and vaccines for the virus, as well as best practices with regards to when to begin HIV-positive people on treatment.

“This paper may be controversial, but people need to know the other side of the story,” Levy said in a press release. “The train left the station and no one is stopping to see whether we did the right thing or not. I’m asking anyone who is involved with HIV/AIDS to pause and focus on some research and clinical areas that need more attention.”

Noting the experiences of long-term nonprogressors, who can live with the virus for 10 to 35 years without treatment and not develop AIDS, Levy questions whether HIV is always fatal.

He calls for greater investigation into the innate immune system, which is the body’s first line of defense against viruses such as HIV. Such research, as well as greater exploration into ways of enhancing the immune response to the virus, could contribute to the search for successful cure strategies and vaccines, he says. He criticizes vaccine researchers for honing their sights too closely on antibodies.

Levy encourages closer consideration of the dual functions of CD8 immune cells, which kill HIV-infected cells and secrete elements that suppress viral production so that an infected cell can continue to operate normally. Better understanding of this latter function may help with crafting a vaccine.

He is wary of the current enthusiasm among many in the medical community for starting people with HIV on treatment immediately after diagnosis, as well as for encouraging a treatment-as-prevention approach to fighting the spread of the virus. He is worried that there may be an excess focus on short-term goals at the expense of potential long-term toxicities of antiretrovirals and the development of drug-resistant strains of the virus.

To read the press release, click here.

To read the essay, click here.