How second person ever was ‘cured’ of HIV
The unidentified ‘London patient’ has been free of the virus for 18 months without viral-suppressing treatment after a stem cell transplant to treat his cancer.
The only other person to have survived the life-threatening technique, and come out of it HIV-free, was so-called ‘Berlin patient’ Timothy Ray Brown, a US man treated in Germany 12 years ago.
Every other attempt in the intervening years has been unsuccessful, many with devastating, deadly consequences.
Experts hailed the news as a ‘milestone’ in the fight against HIV, the virus that causes Acquired Immune Deficiency Syndrome (AIDS), but warned that it does not change the reality much for the 37 million people living with HIV.
Aside from HIV, both men were in the advanced stages of cancer – the Berlin patient with leukemia, the London patient with Hodgkin’s lymphoma.
For them, a life-threatening and complex stem cell transplant was a last-ditch attempt at survival. For most others, that is an unnecessarily dangerous and improbable option compared to taking a daily pill that suppresses their virus so that it is untransmittable, and allowing them to live a long and healthy life.
How a stem cell transplant cured the berlin patient and the London patient
The vast majority of humans carry the gene CCR5. In many ways, it is incredibly unhelpful.
It affects our odds of surviving and recovering from a stroke, according to recent research. And it is the main access point for HIV to overtake our immune systems.
But some people carry a mutations that prevents CCR5 from expressing itself, effectively blocking or eliminating the gene. Those few people in the world are called ‘elite controllers’ by HIV experts. They are naturally resistant to HIV.
If the virus ever entered their body, they would naturally ‘control’ the virus as if they were taking the virus-suppressing drugs that HIV patients require.
Both the Berlin patient and the London patient received stem cells donated from people with that crucial mutation.
The case, published online on Monday by the journal Nature, involved researchers at four United Kingdom (U.K.) universities: UCL, Imperial, Oxford and Cambridge. It will be presented on Tuesday at an HIV conference in Seattle.
The patient was diagnosed with HIV in 2003. He started taking anti-retroviral therapy (or, ART, which are virus-suppressing drugs) to control the infection in 2012.
Ever since 1996, when ART was discovered, it has been recommended as immediate treatment post-diagnosis.
The researchers do not elaborate on why the London patient went nine years before starting on ART.
He developed Hodgkin lymphoma that year. In 2016, he agreed to a stem cell transplant to treat the cancer in 2016.
As with any other patient in his rather unique situation, his doctors hoped they could strike the perfect balance: find a donor with HIV-resistant genes that could wipe out his cancer and virus in one fell swoop.
Most of us carry the gene CCR5. It is very unhelpful in many ways. It hampers our ability to survive strokes and recover from them, according to recent research. It is also the gene that HIV targets and uses as its access point to enter the immune system.
A minority of people in the world carry a mutation of CCR5, which prevents it from expressing, essentially blocking the gene altogether.
As a result, they are naturally resistant to HIV, earning them the name ‘elite controllers’ – because they naturally ‘control’ the virus as if they were on virus-suppressing medication.
As with the Berlin patient, the London patient’s doctors found a donor with a CCR5 mutation.
About one percent of people descended from northern Europeans have inherited the mutation from both parents and are immune to most HIV. The donor had this double copy of the mutation.
That was ‘an improbable event,’ said lead researcher Ravindra Gupta of University College London. ‘That’s why this has not been observed more frequently.’
The transplant changed the London patient’s immune system, giving him the donor’s mutation and HIV resistance.
The patient voluntarily stopped taking HIV drugs to see if the virus would come back – something doctors do not typically recommend because it hasn’t worked since the Berlin patient.
What is more, the Berlin patient’s case was slightly different: he stopped taking his anti-retroviral therapy before his transplant. Out of caution, the London patient’s doctors kept him on his drugs throughout.
ART, taken daily, suppresses the virus to prevent a resurgence.
After six months of daily medication, patients’ viral loads are undetectable, and therefore untransmittable to anyone else.
A few weeks off ART and most patients see their viral load skyrocket. But that was not the case for the London patient.
Tests not only found no trace of R5 virus (the type associated with CCR5), but also no trace of X4 virus, a type of HIV associated with another gene entirely. Eighteen months later without drugs, he remains HIV-free.
Meanwhile, the National Agency for the Control of AIDS (NACA) joined the rest of the world to commemorate the 2019 Zero Discrimination Day. NACA continued to advocate for the protection of Nigerians against HIV-related discrimination at all levels in the country.
Since 2014, the Zero Discrimination Day has been commemorated annually on the 1st of March. It is a global event that promotes diversity and recognizes that everyone counts.
In 2019, the Joint United Nation programme on AIDS (UNAIDS) is highlighting the urgent need to take action against discriminatory laws.
As declared by the Executive Director of UNAIDS, Mr. Michel Sidibé back in 2017 – “Stigma and discrimination is an affront to human rights and puts the lives of people living with HIV and key populations in danger.”
Discrimination can be institutionalized through existing laws, policies and practices that negatively target people living with HIV and marginalized groups. Stigma and discrimination occur in different forms and may not necessarily be a deliberate or conscious action.
NACA emphasised the importance of creating public awareness on the country’s 2014 national HIV and AIDS Anti-Discrimination Act.
Head, Public Relations and Protocol, NACA, Toyin Aderibigbe, said: “The Act makes it an offence to discriminate on the basis of one’s real or perceived HIV status. It also prohibits any employer, individual or organization from requiring a person to take an HIV test as a precondition for employment or access to services.’’
Aderigbigbe urged Nigerians to take advantage of the 2014 Anti-Discrimination Act to know their rights and protect themselves from all forms of HIV-related stigma and discrimination.
Legal protection against HIV-related discrimination is an essential prerequisite for an effective national HIV response. The lack of protective law enforcement and the existence of punitive laws can feed stigma and discrimination and hinder access to HIV services for people living with HIV.
Meanwhile, the UNAIDS is greatly encouraged by the news that an HIV-positive man has been functionally cured of HIV.
“To find a cure for HIV is the ultimate dream,” said Michel Sidibé, Executive Director of UNAIDS. “Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure. However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.”
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