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.”
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.
An Hiv Cure By 2020 A Review Of The Future Of Hiv Therapy
HIV research has come a long way since the disease was discovered in the 1980s. Antiretroviral therapy was a major milestone that has changed the lives of millions, but the goal now is to find an HIV cure before 2020.
Ten years ago, an HIV patient was cured of the disease for the first time anywhere in the world. The Berlin patient, Timothy Ray Brown, received a bone marrow transplant from a donor who was naturally resistant to HIV. He has remained off antiretroviral therapy since the day of his transplant.
When the case was announced, the medical world went nuts. Had we finally achieved an HIV cure?
Unfortunately, the answer remains, not yet. Attempts to replicate the Berlin patient case have not been successful and bone marrow transplants still carry high risks for HIV-positive patients. There have been improvements in antiretroviral drugs to reduce the frequency of the treatment, and HIV vaccines are underway, but an HIV cure has remained elusive.
The year 2020 will bring us close to the 50-year mark after HIV was first described. Several organizations are pushing the development of a first functional cure one that leaves people living with HIV healthy and medication-free without necessarily wiping the virus completely to 2020.
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The First Living Hiv+ Organ Donor
A few weeks after word was out on the success of the London Patient, the world received more hopeful news.
Nina Martinez became the worlds first living HIV-positive person to donate an organ to an HIV-positive recipient, giving the anonymous patient one of her kidneys. Until recently, the medical world considered it unsafe for someone with HIV to live with only one kidney, but thanks to ARVs, those with HIV can be organ donors without the past fear of complications.
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.
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When Will We Have An Hiv Cure
Although there are several approaches that could eventually bring a functional HIV cure, there are still some challenges ahead. One of the biggest concerns around any HIV treatments is the virus ability to quickly mutate and develop resistance, and for many of these new approaches there is still no data on whether the virus will be able to become resistant.
So far, none of these functional cures have reached late-stage clinical testing, meaning it doesnt seem likely that we will meet the goal of having an HIV cure by 2020. However, that year will likely mark an important milestone as the first late-stage trials are due to start that year. If successful, that could bring the approval of the first functional HIV cure in ten years.
This article was originally published in September 2016 authored by Evelyn Warner. It has since been updated to reflect the latest developments in HIV research.Images via Abivax and Shutterstock
What Does All This Mean
Aside from the advancements in cure research the truth is we already have highly effective antiretroviral treatment that is giving people living with HIV the opportunity to live a near-normal life.
While this already an amazing achievement, theres more to be done to improve the lives of people living with HIV including combatting stigma, reducing pill burdens and removing sexual taboos. Cure research is just one of the ways that we can move the HIV response forward.
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Researchers Suspect They May Be Able To Come Up With Hiv Cure
The approach differs from other techniques in its focus on strengthening immunity to the virus and protecting the cells to stymie HIV.
If successful, researchers said, the bodys natural immunity to HIV can be restored. As a result, peoples immune systems will counter the disease like any other.
In a statement, AGT CEO Jeff Galvin said: We want to get these people out of jail and back to normal life.
We see this as critically important. We need to move these people from anti-retroviral control to permanent immunity and we think our project may be able to do that.
Is There A Cure For Hiv And Aids
There is no cure for HIV, although antiretroviral treatment can control the virus, meaning that people with HIV can live long and healthy lives.
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.
Other research is looking for a sterilising cure where HIV is removed from the body completely, but this is more complicated and risky.
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.
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What Should I Do Until Theres A Cure For Hiv
For now, the best thing to do for your health is to test regularly for HIV. Testing is the only way to know for sure if you have the virus.
If youve already tested and your result is positive, youll be advised to start antiretroviral treatment as soon as possible. Treatment is the only way to manage HIV and prevent it from damaging your immune system. It also reduces the risk of passing HIV on to your sexual partners. With treatment, people living with HIV can have long and healthy lives.
Researchers Make First Steps Toward A Cure For Hiv
Researchers have developed a way to pull HIV out of the latent reservoir making the virus visible to the immune system and providing the potential to be killed by treatment.
Part of what has made HIV infection so difficult to cure, is that once the virus enters the body, some of it hides dormant inside of the cells, making it essentially invisible to both the immune system and antiretroviral drugs. This hiding virus is known as the ‘latent reservoir’ and it is what prevents a cure for people living with HIV.
Treatment with combined anti-HIV drugs can bring down virus in the body so that it cannot be measured by conventional tests and a person lives disease free, however, if an individual ever stops their life-long therapy, some of the virus will come out of hiding and rapidly re-emerge, while some of it stays dormant in the cells.
Eric Arts, Professor at Schulich Medicine and Dentistry at Western University and principal investigator on the study, said: “The aim is to get it all out of dormancy with a targeted punch, so the remaining virus can be killed
“Now that we’ve shown that this can be done with patient samples at early HIV disease, the hope is this will lead to targeted cure strategies.”
“If the virus is not replicating, the drugs can’t have an effect on it. By reactivating the virus, we can either inhibit it through antiretroviral therapy or it can be targeted by the body’s immune response.”
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The London Patient Joins The Berlin Patient As The Second Person In History To Be Cured Of Hiv Which Is Achieved Via Transplant Of Rare Hiv
Adam Castillejo is a 40-year-old patient who has become the second person in the world to be cured of HIV. He joins the Berlin patient in having no further active HIV infection in his body.
Professor Ravindra Kumar Gupta, lead on the research team, said: The London patient has been in HIV-1 remission for 30 months with no detectable replication-competent virus in blood, CSF, intestinal tissue, or lymphoid tissue.
We propose that these findings represent HIV-1 cure.
This is an incredible moment for people living with HIV across the world.
Dr Hans Kluge, WHO Regional Director for Europe, commented: I remember when a diagnosis of HIV seemed like a death sentence. Now, with proper treatment, people with HIV can live without fear of AIDS.
In light of this second cured patient, the future looks even more positive than the hopes explained by Dr Kluge.
Promising New Research May Soon Help Treat And One Day Cure The Chronic Disease
Just over a decade ago, researchers announced a first: They had cured a patient of HIV. Known as the Berlin patient, Timothy Ray Brown had needed a bone marrow transplant to treat his acute myeloid leukemia. Doctors used the opportunity to replace his bone marrow using stem cells from a donor with gene-based HIV immunity. It worked: Browns leukemia was cured, as was his HIV. More recently, in 2019, a second patient, this time being treated for Hodgkins lymphoma, was similarly cured in London.
But although these are the most famous stories where patients have been cured from HIV, their treatments represent just one option of many new approaches for tackling the virus and one of the least widely applicable. Its too invasive and too risky to conduct a bone marrow transplant on someone who doesnt already have cancer that requires the procedure especially considering most patients with an HIV diagnosis and access to care can effectively control the disease with drugs. In fact, a patient on antiretroviral therapy, or ART, today has the same life expectancy as a person without HIV.
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Treatment Reduces The Amount Of Hiv In The Blood
- The amount of HIV in the blood is called viral load.
- Taking your HIV medicine as prescribed will help keep your viral load low and your CD4 cell count high.
- HIV medicine can make the viral load very low . Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.
- HIV medicine can make the viral load so low that a test cant detect it .
- If your viral load goes down after starting HIV treatment, that means treatment is working. Continue to take your medicine as prescribed.
- If you skip your medications, even now and then, you are giving HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.
- Getting and keeping an undetectable viral load is the best way to stay healthy and protect others.
How It Could Be Done For Others
Brown and Castillejos cures, as transplants, were so-called allogenic, meaning that the HIV-resistant cells came from another person. Better would be autogenic transplants, in which immune system cells are taken from a person with HIV, genetically altered in the lab dish to make them resistant to HIV, and then re-introduced. This type of procedure by treatment advocate Matt Sharp, who underwent one.
The repertoire of gene therapies is not restricted to CCR5 deletion. Gene therapy is immensely versatile, and could be used in a number of ways.
Instead of using gene therapy to make cells resistant to HIV, it could directly repair defective genes in cells by means of cut-and-paste technology such as CRISPR/Cas9. This is already being used in trials for some genetic conditions such as cystic fibrosis and sickle-cell anaemia. Given that HIV-infected cells are also defective in the sense that they contain lengths of foreign DNA that shouldnt be there, they are amenable to the same molecular editing. Early trials have produced promising results but the challenge, as it has been in a lot of gene therapy, is to ensure that the cells containing DNA are almost entirely eliminated.
“Timothy Ray Brown and Adam Castillejo were both given bone marrow transplants from donors whose T-cells lacked the gene for the CCR5 receptor.”
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Strategies To Cure Hiv
Whilst a person living with HIV can suppress the virus with antiretrovirals, there is no cure. A cure for HIV would be the total eradication of the virus from the body. However, this is not the only option that scientists are looking into. Here are some of the strategies scientists are looking into for an HIV cure.
Light Painting | JonathanCohen via Photopin
Second Patient Appears Cured Of Hiv Giving Hope To Hiv Positive People
Timothy Ray Brown, the first person to be cured of H.I.V., and Dr. Ravindra Gupta, a virologist, speak on the second patient who appears to have been cured of an H.I.V. infection. That patient has chosen to remain anonymous.
Yes, I would like to meet the London patient very much. I would say, take your time in If you want to become public, do it. And its been very useful for science and for giving hope to H.I.V. positive people. We waited 16 months before stopping in the post-transplant period just to make sure that the cancer was in remission, the patient was well and that the measures we had of the H.I.V. reservoir in the body showed that there was very, very little virus there if any at all. And at that point, we stopped the treatment. And so were now 18 months in and were confident that this will be a long-term remission, but its too early to say as to whether this is a cure or not.
Most experts who know the details agree that the new case seems like a legitimate cure, but some are uncertain of its relevance for AIDS treatment overall.
Im not sure what this tells us, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. It was done with Timothy Ray Brown, and now heres another case ok, so now what? Now where do we go with it?
These are dreams, right? Things on the drawing table, Dr. McCune said. These dreams are motivated by cases like this it helps us to imagine what might be done in the future.
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Still Searching For A Cure
Research is still ongoing to find a way to beat HIV. Until there is a cure, HIV-infected people should access ARTs as soon as possible and stick to their daily dose.
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Dr Khosi Kubeka is a Senior Lecturer in UCTs Department of Social Development, having joined the department in 2010 as an AW Mellon Postdoctoral Research Fellow. Dr Kubeka represents the interests if the University of Cape Town on the DTHF board. She currently teaches research methods and coordinates all the research programmes in her department. Dr Kubekas areas of research and interest lie in Youth Developmental Wellbeing, specifically youth exclusion and inclusion in education, health and the economy, as well as youth contribution to community development.
Professor Robin Wood has had a distinguished career in medicine, both within South Africa and further afield. He is currently the Emeritus Professor of Medicine at the University of Cape Town and director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine. His first foot on the ladder was as student medical officer at a hospital in Peru, followed by stints in the United Kingdom and later, Zambia. In 1990 he took up a Clinical Fellowship at Stanford University.