Ask the Doc: A Cure for HIV?

by Demetre Daskalakis

EDGE Media Network Contributor

Tuesday March 25, 2014

Dr. Demetre Daskalakis
Dr. Demetre Daskalakis  

Five years ago, experts would have scoffed at the idea that HIV can be cured, but with some very high profile cases that have been publicized and evaluated by researchers, it looks as if this is at the top of the research agenda. In this edition of Ask the Doc, I will discuss some of the cases and what they may mean for the next generation of research for an HIV cure.

Q: I have heard about a man cured of HIV after treatment for cancer, a baby cured after early therapy and 14 people in France with a "functional cure." Is this true? What does this mean for me?

A: So, these reports are true, but need some clarification. The first patient that prompted this new interest in a cure for HIV was a man named Timothy Ray Brown. Initially called the "Berlin patient," Mr. Brown was diagnosed with HIV in 1995 and was on therapy.

Then in 2005 he was diagnosed with leukemia. To treat this leukemia, he had a bone marrow transplant that involved giving him a chemotherapy regimen that erased his immune system while killing his tumor. After that chemotherapy, he was given donor cells from an individual who harbored a rare genetic mutation (CCR5delta32) that makes individuals resistant to HIV infection. Sure enough, his HIV never came back (off medications) and could not be found in tissues in his body.

The baby story is a bit different. In this case, a baby born with HIV in its blood was given early treatment within 30 hours of birth. Due to poor follow-up, the baby stopped medications 18 months after they had been started. Subsequent tests reveal that the virus is detectable off medications, but at very low levels. Scientists believe that this early treatment may have avoided the creation of a reservoir of virus in this baby and may have resulted in a "functional cure," which means that HIV is there in low levels but not causing any problems.

The last report of 14 adults with a "functional cure" is kind of old news that is new again. These individuals were treated for acute HIV infection very early on, within 35 days and 10 weeks of infection and then subsequently went off medications for one reason or another. Of the 70 people in the study, 14 did not have relapse of virus in their blood. This group reinforces the observation that treatment during early infection in adults may lead to the ability to control HIV replication through immune control of the infection.

This is all good news. The lessons are that we should consider treating HIV aggressively and as early as possible. These cases may also be the clue to researchers for building strategies to eradicate or cure HIV.

Q: What are the current strategies for finding a cure for HIV? What are researchers doing?

A: HIV cure research is a hot topic. With the cases we discussed above, researchers are looking to create strategies that might lead to eradication of HIV and a cure! These strategies are a while off, but hope has never been as high as now.

Investigators are focusing a lot of attention on the "latent reservoir" of HIV as the main barrier to curing infection. After someone is exposed to HIV and virus enters his or her blood stream, many cells become infected with the virus. Some of them may live for over 50 years in a quiet state, not doing anything but providing HIV a home safe from the HIV medications that we use to treat virus.

Researchers are using the cases of Timothy Ray Brown, the Mississippi baby and the 14 functional cures to look at strategies that include treating infection very early and identifying drugs less toxic than cancer chemotherapy that might be used to get rid of the "latent reservoir" hiding place of the virus.

You can learn more at the Adult AIDS Clinical Trials Group (aactg.org) about study sites near you that may be conducting studies in these strategies.

Ask the Doc

This story is part of our special report titled Ask the Doc. Want to read more? Here's the full list.

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