Cure for AIDS?

A stem-cell treatment put a London cancer patient’s HIV into remission, marking the second such reported case and reinvigorating efforts to cure the AIDS-causing infection that afflicts some 37 million people globally.

Background 

Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms.

As the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumours that rarely affect people who have working immune systems. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS).

HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading. HIV originated in west-central Africa during the late 19th or early 20th century. AIDS was first recognized by the United States Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.

Analysis 

University College London researchers made the announcement at the annual Conference on Retroviruses and Opportunistic Infections in Seattle that a cure for HIV infection is possible.

The patient has been in remission for 19 months, the International AIDS Society said in a statement. That’s too soon to label the treatment -- which used hematopoietic stem cells from a donor with an HIV-resistance gene -- as a cure, researchers said in a study in the journal Nature. Hematopoietic stem cells give rise to other blood cells.

Acute myeloid leukaemia patient Timothy Brown, who became known as the “Berlin patient,” was treated aggressively more than a decade ago in an HIV-curing approach that hasn’t been successfully repeated until Ravindra Gupta and colleagues showed the effectiveness of a less aggressive form of treatment.

Gupta’s case was in an HIV-positive man with advanced Hodgkin’s lymphoma who received a transplant of hematopoietic stem cells from a donor with two copies of the so-called CCR5 gene mutation -- the same one allegedly edited by He Jiankui that led to the birth of the world’s first gene-edited babies last year.

“Coming 10 years after the successful report of the ‘Berlin Patient,’ this new case confirms that bone marrow transplantation from a CCR5-negative donor can eliminate residual virus and stop any traces of the virus from rebounding,” said Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne, in a statement.

“The so-called London Patient has now been off ART for 19 months with no viral rebound which is impressive, but I would still be closely monitoring his viral load,” said Lewin, who is also co-chair of the International AIDS Society’s Towards an HIV Cure initiative.

The London patient has no detectable HIV virus, Gupta and colleagues said. “We speculate that CCR5 gene therapy strategies using stem cells could conceivably be a scalable approach to remission,” they said.

Scientists at IciStem, a consortium of European scientists researching use of stem cell transplants to treat the illness, say the London patient received a bone-marrow transplant in 2016 and was given immunosuppressive drugs. He stopped taking his HIV medication in September 2017.

There are important limitations to applying the findings of the London patient to an HIV cure, said Anthony Kelleher, director of the Kirby Institute at the University of New South Wales in Sydney. Still, the London case shows that “HIV cures are possible,” he said.

Assessment 

Our assessment is that a potential cure for one of mankind’s most debilitating disease is a major step in resurrecting societies and countries ravaged by HIV/AIDS. We believe that if a cure is possible, the innovator could partner with local pharmaceutical companies situated in the countries to ensure good manufacturing practice,  efficient stocking, distribution and affordability.

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