A cure for HIV? Feasible but not yet realized

Phillip Cunningham
March 9, 2019

Infection with HIV nearly always led to AIDS, which in turn was nearly always fatal. Gupta pointed to recent experiments with babies in China, who had their genes edited in the womb to make them HIV-resistant (a controversial trial). However, like Brown, the London patient experienced some nasty side effects, including graft-versus-host disease in which the donor immune cells attack the recipient's immune cells.

A third patient has reportedly made a successfully transition off HIV medication and is now free of the virus. To some that means a cure; however, as Dr Annemarie Wensing of the University Medical Centre Utrecht, who was quoted by The NYT, said, "We don't have any worldwide agreement on what time without viral rebound is necessary to speak about cure".

Bone marrow transplants are inherently risky and are considered a last resort treatment, so it is unlikely they could be used en masse to treat HIV patients. He developed Hodgkin lymphoma that year and agreed to a stem cell transplant to deal with the most cancers in 2016. There's also a high risk of infection and death during and after the procedure. In both cases, the bone marrow was taken from donors with natural resistance to HIV because of a genetic mutation in two copies of their CCR5-delta 32 gene, which encodes a critical protein that allows HIV to enter and infect cells.

If left untreated, HIV reduces the number of CD4 cells (T cells) in the body which in turn, damages the immune system and makes it more hard for the body to fight off infections and some other diseases. But when CCR5 malfunctions, Time's Alice Park explains, immune cells are able to strengthen their defense system and ward off the infection.

However, Otwoma described the cure as an antiretroviral therapy remission, where the HIV reservoir is not completely eradicated but altering the immune system to induce long-term control of HIV. After receiving treatment, both patients were eventually taken off their anti-retroviral medications and subsequent examination showed that that even with very sensitive blood tests, the team could not detect HIV in their blood. "However, the case is important as it reaffirms that the CCR5 receptor is a candidate for future research approaches in HIV remission".

Of the small group of H.I.V. -positive cancer patients who have agreed to undergo transplants similar to Brown's, several have died from their underlying cancer or complications related to treatment. Otwoma said although there has been a notable decline in new HIV infections, continued effort is still needed to develop an efficacious, accessible and affordable HIV vaccine. Lower left panel shows the target for HIV, the CD4+ T-cell.

In 2017 - the latest annual figures available - there were just under 37 million people living with HIV and 1.8 million people became newly infected with the virus. Neither should anyone else.

Tez Anderson, who founded Let's Kick ASS (AIDS Survivor Syndrome) and has lived with HIV since 1983, said he fears the London news will reinforce the misperception that AIDS is no longer a epidemic thanks to advances in treatment, even though some 40,000 new HIV cases are reported in the United States every year.

Most importantly, the HIV community learned that Brown's case was not unique.

"All HIV cure approaches in general are in their infancy", he said in a telephone interview.

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