D Gregory Smith

HIV Cures Come With a Price

Filed By D Gregory Smith | July 03, 2013 4:30 PM | comments

Filed in: Living
Tags: amFAR, HIV cure, HIV/AIDS, stem cell research

HIV medsToday, amfAR grantee Dr. Timothy Henrich announced two HIV-positive patients who have undetectable levels of HIV after undergoing stem-cell transplants at the 7th annual International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

We've had some excellent news about the curing of HIV-infected people in the past year. But it comes at a price.

It's important to note that the individuals involved received intensive care and went through extreme discomfort in order to eradicate the virus from their bodies. It's not something that we'll be able to replicate for the general population anytime soon.

And I think we need to remember that people are still dying of HIV-related causes every day - thousands of people. And new infections aren't really slowing down - even in the First World where there is convenient access to safe sex supplies. There's still a disconnect. There's still ignorance and apathy out there.

It's still good news however.

From amFAR:

The patients had been on long-term antiretroviral therapy for HIV when they developed lymphoma. To treat the cancer, the patients underwent reduced intensity chemotherapy followed by stem-cell transplants. Since the transplants, Dr. Henrich has been unable to find any evidence of HIV infection.

Dr. Henrich was awarded a grant through the amfAR Research Consortium on HIV Eradication (ARCHE) after presenting preliminary findings on these patients at the International AIDS Conference last July. With support from amfAR, he conducted a clinical study in which his research team withdrew the patients' antiretroviral therapy and performed several sophisticated assays looking for signs of viral rebound in blood and other tissues. One patient has been off treatment with no detectable virus for approximately 15 weeks, and the second patient for seven weeks, with similar results. However, it is too soon to draw any definitive long-term conclusions.

It is also unclear how long viral rebound might take in a patient whose viral reservoirs have been dramatically depleted, but not eradicated. According to amfAR/ARCHE grantee Dr.Robert Siciliano of Johns Hopkins University, it may take over a year. Previously a patient in a study by the National Institutes of Health had gone 50 days after treatment withdrawal without viral rebound. Dr. Henrich's patients are at or beyond this threshold, and more definitive answers will emerge as these patients continue to be closely monitored.

"These findings clearly provide important new information that might well alter the current thinking about HIV and gene therapy," said amfAR CEO Kevin Robert Frost. "While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV."

The first person to be cured of HIV, Timothy Brown ("the Berlin patient"), also underwent a stem-cell transplant to treat his leukemia. These new cases differ significantly, however, in that the stem-cell donors lacked the genetic mutation (CCR5 delta32) that renders a person virtually resistant to HIV infection. Nor did Dr. Henrich's patients undergo the intensive chemotherapy or total body irradiation that preceded Timothy Brown's stem-cell transplant.

"Dr. Henrich is charting new territory in HIV eradication research," said amfAR Vice President and Director of Research Dr. Rowena Johnston. "Whatever the outcome, we will have learned more about what it will take to cure HIV. We believe amfAR's continued investments in HIV cure-based research are beginning to show real results and will ultimately lead us to a cure in our lifetime."

I still can't help but think we've not done our best in response to this epidemic - especially in the last decade. I wonder if, as a community, we settled for simply not dying as a substitute for true health.

If so, what does that say about our self-esteem, self-care and community spirit? Have we lost interest in each other beyond the obvious?

That's a heavy price to pay.


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