Could This Cure Mean The End Of The Hiv Epidemic
Unfortunately, there are societal and personal obstacles outside of the literal cure being scaled up and made available.
The HIV epidemic in North America continues to have worse outcomes across racial lines, and overlaps with a severe opioids epidemic in socio-economically worse off areas.
While Black people make up 13% of the US population, they are 43% of HIV-related deaths in 2018. These entwined factors create a difficulty of treatment for medical care is expensive, inaccessible and stigma continues to exist about having HIV in the first place.
Currently, the UK have made it possible for people living with HIV to access the COVID vaccine without declaring their medical status.
Dr Errol Fields, Johns Hopkins University School of Medicine, said: The racial disparities that so rapidly emerged with COVID-19 are a reminder that until these inequities are addressed, disparities in HIV and COVID-19 outcomes will persist and ending the HIV epidemic will remain elusive.
Across the world, HIV is a huge problem for women and girls who have to trade themselves sexually in exchange for access to resources like food, water and medicine.
While many infectious diseases like HIV/AIDS do not have a direct link to the environment in their transmission patterns or vectors, disasters such as drought can still have a significant influence on the social conditions that shape and enhance vulnerabilities, said the researchers.
How Does It Work
CCR5 is the most commonly used receptor by HIV-1 – the virus strain of HIV that dominates around the world – to enter cells.
But a very small number of people who are resistant to HIV have two mutated copies of the CCR5 receptor.
This means the virus cannot penetrate cells in the body it normally infects.
Researchers say it may be possible to use gene therapy to target the CCR5 receptor in people with HIV.
It is the same receptor the now jailed Chinese scientist He Jiankui worked on when he created the world’s first gene-edited babies.
What’s Stopping Us Hiv Researchers From Working On Experiments Like This
What’s the status of that?
Thus far, we’ve had two individuals who are virtually identical twins of the Berlin patient that is, they are 40-year-old individuals who were treated with HAART for HIV for many years that unfortunately developed acute myelogenous leukemia and needed, and got, treated with chemotherapy, but will need bone marrow transplants.
Unfortunately, there are two obstacles. The first obstacle is getting a match. The person I was so enthused about here at our own hospital had no matches among the 13 million adult donors that we searched. There were some acceptable matches from our cord blood program, which uses blood from the placenta where you can get stem cells. The trouble is that because you don’t get a whole lot of blood from a placenta, and therefore you don’t get a whole lot of stem cells, you often need to use two or three of them. The statistical improbability of finding two or three exact matches that will also be delta32 CCR5 negative is just astronomical.
Basically, we cannot find matches for the individuals that we’re presented with. The hope is though that somewhere we will find a match.
Why can’t you use the people in Germany?
It’s a worldwide match, so the German registry’s on our registry. However, the tissue-type match has to be exact. Remember, I mentioned that Dr. Hütter initially went about finding a match the way we all do, by searching among the 13 million people in the worldwide registry, and he found 232 acceptable matches.1
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FAST FACTS
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There is no cure for HIV, although antiretroviral treatment can control the virus, meaning that people with HIV can live long and healthy lives.
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Most research is looking for a functional cure where HIV is permanently reduced to undetectable and harmless levels in the body, but some residual virus may remain.
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Other research is looking for a sterilising cure where HIV is removed from the body completely, but this is more complicated and risky.
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Trials of HIV vaccines are encouraging, but so far only offer partial protection.
There is no cure for HIV yet. However, antiretroviral treatment can control HIV and allow people to live a long and healthy life.
For some people, treatment can reduce the level of HIV in their body to such a low amount that they are unable to pass it on . Having an undetectable viral load can keep you healthy, but its not a cure for HIV. To maintain an undetectable viral load a person must keep adhering to their antiretroviral treatment.
What Tests Confirmed No Hiv Was Present In Berlin Man
Dr. Laurence, what tests were done to confirm that there was no HIV left in the Berlin man’s body?
An article was published about this patient a few months ago in The New England Journal of Medicine.1 Just before the article was published, I organized a think tank sponsored by amfAR at MIT ‘s Endicott House, where we got together scientists from around the world, including Dr. Hütter, to talk about what additional tests could be done apart from what had already been done in Germany.
For example, in The New England Journal of Medicine article, it mentions that before that transplant, the patient had an undetectable viral load. Of course, he was on drugs. When he was taken off the drugs, he still had an undetectable viral load, but the tests that they were using are the standard kinds of tests that a person with HIV might get when he or she walks into a doctor’s office .
One of the scientists that I invited to this meeting said, “50 copies per 20 drops? I can get less than a third of a copy of virus in 20 drops.” So we had that scientist test the patient’s blood and it was negative. So there is no virus by the most sensitive ways that you could possibly look for virus.
Did you also give this man an antibody test?
It has been about two and a half years since the patient has been off of all of his antiviral drugs and had the transplant, and he still has absolutely no detectable virus, either active virus or latent virus.
All were negative for virus.noall
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Why Some People Can’t Get Hiv And An Explanation Of Ccr5
Some people don’t understand how HIV enters a cell. Could you explain that and why CCR5 is important?
Any virus, any bug that you get infected with only does you damage because that bug has gotten inside your cells. If it’s floating around not activating anything, not harming anything, it’s irrelevant and it’s going to get washed out.
HIV gets into critical cells of the immune system — the T cell, basically — through two doors. One door is called CD4, and that’s why we count CD4 cells. But the critical door is called CCR5. If you don’t have CCR5 sitting on top of your T cells, it is virtually impossible for you to be infected with virtually all strains of HIV.1
So, by having this mutant given by this donor, the person’s cells are resistant to being infected with HIV. You could ask, “It’s a mutation that is found only in about 1.5 percent of Caucasians, 4 percent of Scandinavians. Why is it there? Where’d it come from? Is it harmful?”
We know it prevents HIV, but surely evolution didn’t create this mutation just to stop one from getting HIV 100,000 years ago .
Truthfully, we don’t know why. The hypothesis has always been that there must have been some huge epidemic way back when that was present in Western Europe, in Scandinavia, that didn’t occur in Asia and didn’t occur in Africa, that wiped out so many people who didn’t have this kind of spontaneous mutation.
The Challenge Of Curing Hiv
Because of the nature of HIV, discovering a cure comes with some specific challenges. The most significant of these challenges is the viruss ability to hide itself and lay dormant in pockets of host cells that are unrecognised as harbouring HIV by the immune system. Even if an individual has successfully suppressed their HIV through ARV treatment, the hidden HIV, called the latent reservoir, can re-emerge if ARV treatment is stopped.
Because of this underlying barrier, examples of HIV cure have been few and far between throughout the entire history of the HIV epidemic. In fact, there have been only two instances of confirmed HIV cure, in which HIV cannot be found in in blood or biopsies of two PLHIV , and these patients went on to successfully stop daily ARV treatment and did not experience a rebound in their HIV. 1
These individuals were cured of their HIV after treatment for their separate cancer diagnosis, which required a series of difficult and intensive treatments. While their treatments were extremely high risk and not amenable to wide scale implementation, these instances of cure bring hope of what is possible in our efforts to end the HIV epidemic.
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Mapping The Path Forward To A Cure For Hiv
How do you find a cure for HIV? Our approach is simple: collaboration. We realised a long time ago that we could go much further in our efforts if we worked to bring together the best brains in the business to focus on exploring every avenue, mechanism and compound towards our end goal of an HIV cure.
For that reason, ViiV Healthcare became half of a unique public-private research partnership that began in 2015 with the University of North Carolina at Chapel Hill , creating a dedicated HIV Cure center and a jointly owned new biotechnology company, Qura Therapeutics, that focus exclusively on discovering a cure for HIV.
This collaboration, the first-of-its-kind in the field of HIV cure, has unified the strengths of a world-renowned public research institution and a pioneering private industry leader. Together, ViiV Healthcare and UNC scientists became part of a joint team based in labs on the UNC Chapel Hill campus, creating and working together on several exciting areas of research to cure HIV.
What Can People Do To Accelerate The Research For A Cure
It’s all very exciting. What could people do to accelerate this research?
Support research. It is the only way we’re ever going to have additional treatments and eventually a cure for this disease.
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Stay knowledgeable about this disease. Don’t let it fall off the radar map. Too many people think that since we have drug therapies that permit many people an almost normal lifespan, this is over and we can move on to the next cause. But it’s really not like that. There are serious side effects of the drugs that we have.
If we haven’t stopped this disease everywhere, then we’ve stopped it nowhere. It’s really important to eventually cure it everywhere. It’s very important to advocate for a vaccine because we’ve never ever stopped any viral epidemic through treatment alone. It’s always required a vaccine. And vaccines are going to be incredibly difficult to develop in HIV.
So stay active. Make your friends and your legislators interested and aware of the fact that you’re still interested.
amfAR provides grants to researchers to continue their research?
Right.
After the discovery of this patient, did amfAR’s priorities change and shift? Is more money now being allocated towards finding a cure?
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Second Person Ever To Have Been Cured Of Hiv Reveals Their Identity
“I want to be an ambassador of hope.”
Shutterstock
As COVID-19 tears across the world leaving a path of destruction in its wake, infectious disease seems to have the upper-hand on humankind at the moment.
But now for some very good news.
In March 2019, scientists announced that the second person ever had been cured of HIV. Now, the scientists detail this incredible achievement for the first time in a new case report published Tuesday in the journal The Lancet HIV.
The paper confirms that no active viral infection can be detected in the patientâs blood 30 months after ceasing antiretroviral therapy. They are, effectively, cured.
Until now, the patientâs identity was anonymous, referred to in the literature only as the âLondon patient.â
But on Monday of this week, TheNew York Times unveiled his identity for the first time: His name is Adam Castillejo.
Have There Been Any Breakthroughs
One reason to hope for a cure for HIV is that experimental treatments seem to have worked in a handful of people already.
The Berlin Patient: In 2008, a man with HIV named Timothy Ray Brown was effectively cured while living in Germany. Researchers treated his blood with a stem cell transplant for leukemia, but the treatment also cured his HIV. His stem cell donor carried a mutation of an HIV-related gene called CCR5. This mutation makes a person almost completely resistant to infection. Brown was the only person to be cured of HIV until 2019, when two others were effectively cured with a similar stem cell therapy.
Visconti Cohort: In 2010, a baby born with HIV in Mississippi began ART soon after birth and was in remission for 2 years after they stopped, but the virus did come back. A trial called the Visconti Cohort studied 20 people with HIV in France. They also started ART within weeks of infection. They were able to stop taking the drugs and still have low levels of HIV years later. Another trial of 15 children with HIV in Thailand had similar results. Itâs important to remember that these were controlled studies if you have HIV, you should never stop ART without talking to your doctor.
These are positive signs, but the studies are very small. We need more research on these potential cures to be able to develop treatments that would safely work on many people, not just a small number.
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Was A Patient Cured Of Hiv Without A Stem Cell Transplant
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In a study explaining how certain patients can control HIV without medication, researchers reported what one of them called a provocative idea.
In one of the so-called elite controllers, the researchers were unable to detect any HIV in more than a billion cells, raising the possibility that the patient has achieved a sterilizing cure.
To date, only two people are believed to have been cured of HIV, most recently the so-called London patient. Both achieved sustained remission after undergoing stem cell transplantation, a risky treatment that is not suitable for most patients.
Healio spoke with Xu G. Yu, MD, group leader at the Ragon Institute of MGH, MIT and Harvard and associate professor of Medicine at Harvard Medical School, about the possibly cured patient, the studys other findings and their implications for HIV patient care.
Q: What are this studys key takeaways?
Our data indicate that for future evaluation of cure strategies, not only the changes in the quantity of intact viruses, but also the changes in the chromosomal locations and integration sites of intact viruses should be analyzed as an outcome parameter or endpoint.
It may be possible to achieve a sterilizing cure of HIV through natural immunity. Notably, a sterilizing cure of HIV has so far been achieved only after hematopoietic stem cell transplantation.
What Is The Treatment
Stem-cell transplants appear to stop the virus being able to replicate inside the body by replacing the patient’s own immune cells with donor ones that resist HIV infection.
Adam Castillejo – the now 40-year-old “London Patient” who has – has no detectable active HIV infection in his blood, semen or tissues, his doctors say.
It is now a year after they first announced he was clear of the virus and he still remains free of HIV.
Lead researcher Prof Ravindra Kumar Gupta, from the University of Cambridge, told BBC News: “This represents HIV cure with almost certainty.
“We have now had two and a half years with anti-retroviral-free remission.
“Our findings show that the success of stem-cell transplantation as a cure for HIV, first reported nine years ago in the Berlin Patient, can be replicated.”
But it will not be a treatment for the millions of people around the world living with HIV.
The aggressive therapy was primarily used to treat the patients’ cancers, not their HIV.
And current HIV drugs remain very effective, meaning people with the virus can live long and healthy lives.
Prof Gupta said: “It is important to note that this curative treatment is high-risk and only used as a last resort for patients with HIV who also have life-threatening haematological malignancies.
“Therefore, this is not a treatment that would be offered widely to patients with HIV who are on successful anti-retroviral treatment.”
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What It All Means
All of these results are incredibly hopeful. They show that new approaches to HIV treatment are becoming increasingly effective and that researchers are slowly getting closer to finding a true cure.
That being said, its important to remember that the successes of the Berlin patient and the London patient occurred under very special circumstances. The procedures were intended to treat cancer, and they came with a large price tag and an even larger risk. After the Berlin Patient, many of the attempts to replicate his treatment ended with the virus coming back, or with HIV+ patients dying from their cancer. Brown himself almost died immediately following the procedure because of the toll it took on his immune system.
In terms of the major developments using the CRISPR method, its important to remember that gene editing is still a very new technology. While eliminating HIV in mice was certainly a major feat, were still a while away from being able to safely test the CRISPR method on humans.
These discoveries also do not change the current situation for most of the 38 million people currently living with HIV, the majority of whom are in sub-Saharan Africa. Given roughly a third of all people living with HIV still lack access to daily HIV medication, neither a rare, dangerous, and costly procedure, or an unproven intensive treatment regimen, is a realistic solution to the AIDS pandemic at this time.