Scientists have possibly cured HIV in a woman for the first time
By: April Carson
Four years after receiving a cutting-edge therapy, the "New York patient" is no longer taking HIV medication and remains "asymptomatic and healthy," according to researchers.
For the first time, an American research team claims to have successfully treated HIV in a woman. These scientists used a cutting-edge stem cell transplant technique that they expect will expand the pool of people eligible for similar treatment to several dozen individuals each year, based on their previous achievements and failures in the field of HIV cure research.
Their patient joined a select group that includes three HIV-positive men who have been cured, or very likely cured, by scientists. Researchers also recognize two women whose own immune systems appear to have completely destroyed the virus.
According to Dr. Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, one of the NIH's numerous divisions that funds the research network behind the new case study, "the accumulation of repeated apparent victories in treating HIV" continues to provide hope.
“It is critical that there be more success along this path,” he added.
In the first case of what was determined to be a successful HIV cure, researchers treated Timothy Ray Brown, also known as "the Berlin patient," for acute myeloid leukemia. He received a stem cell transplant from a donor with a rare genetic defect that endowed his immune cells with natural resistance to HIV. The technique employed in Brown's therapy, which was initially revealed in 2008, has now apparently cured HIV in two additional people. However, it has also failed in several others.
The researchers' hypothesis is that a person's host immune system will react by infiltrating and destroying the tumor, as well as any HIV cells that remain after treatment. The process destroys both the original immune system and dormant viral copies in hidden immune cells. Newly generated viral copies would be unable to infect other immune cells if transplanted stem cells engrafted successfully and produced new viral copies.
It is wrong to pursue an HIV cure through a stem cell transplant in anyone who does not have a potentially deadly cancer or other condition that makes them a candidate for such dangerous treatment, according to experts.
“While we’re extremely encouraged by the new case of a possible HIV cure,” Dr. Deborah Persaud, a pediatric infectious disease specialist at Johns Hopkins University School of Medicine and chairperson of the NIH-funded scientific committee behind the new case study (the International Maternal Pediatric Adolescent AIDS Clinical Trials Network), told reporters in an email, “while stem cell therapy is still not a viable option for most individuals living with HIV, it is nonetheless ‘not feasible' for most people living with HIV due to limitations in quality and availability of stem cells.”
“Nevertheless, we remain dedicated to moving forward with research that may help us find a cure for HIV in the future,” she said.
Last week’s announcement was greeted with enthusiasm by outside experts who witnessed 12-year-old Timothy Brown (the Berlin patient) survive for more than six years after receiving his own stem cell transplant. Eight years after Brown’s treatment, researchers are unable to detect HIV in his body.
The Weill Cornell group developed the technique used to treat the New York patient, known as a haplo-cord transplantation, in order to expand cancer therapy alternatives for individuals with blood malignancies who lack HLA-identical donors. The cancer patient first receives an umbilical cord blood transplant, which includes stem cells that represent a powerful nascent immune system. A larger graft of adult stem cells is given to them the next day. Adult stem cells develop quickly at first, but over time they are entirely replaced by cord blood cells.
Cord blood is more adaptable than adult stem cells, typically needs less of a close HLA match to work, and causes fewer problems. Cord blood, on the other hand, does not usually offer enough cells to be effective as a cancer therapy in adults, therefore such transplants have traditionally been restricted to pediatric oncology. The additional transplantation of stem cells from an adult donor, which gives a greater number of cells, can help compensate for the lack of cord blood cells in haplo-cord transplants.
The adult donor cells' job is to assist with the early engraftment process and make the transplant more simple and secure. The Weill Cornell team and its collaborators identified the HIV-resistant genetic aberration in the umbilical cord blood of a newborn donor for the New York patient, who has a mixed-race background. To combine the two transplants, they utilized embryonic stem cells derived from an adult donor. Both donors were only half HLA matches to the woman, but because of the two transplants combined, this was not an issue.
Why is it so difficult to cure HIV?
The ultimate problem with curing HIV is the virus's ability to integrate into a patient's genome, making it impossible to eradicate or create anti-bodies against. In fact, it has been estimated that as many as one in ten people living with HIV possess segments of the virus as integrated latent proviruses within their DNA.
When the highly successful antiretroviral therapy for HIV was approved in 1996, Dr. David Ho, a leading innovator and director of the Aaron Diamond AIDS Research Center in New York City, predicted that if enough time were given, these therapies might ultimately destroy the virus from the body.
There have been a few of instances of patients who were started on Antiretrovirals immediately after getting HIV, then stopped treatment and remained in viral remission for years without any virus reversion.
Ho's prediction has thus far proven wrong. During the previous quarter century, HIV cure researchers have progressively refined their understanding of just how difficult it is to not only cure HIV but also to develop curative treatments that are both effective and safe.
Because the virus inserts its genetic code into long-lived immune cells that will enter a resting state — that is, they will cease churning out new viral copies — the virus has such a permanent presence in the body. Antiretrovirals only target replicating cells, so HIV can stay under their radar for longer periods of time if it hides in resting cells. Such cells may restart their engines at any moment and flood the body with much more virus if no HIV therapy is administered. That's why scientists are excited about the new finding, but they remain cautious.
For now, they're calling it a "functional cure."
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About the Blogger:
April Carson is the daughter of Billy Carson. She received her bachelor's degree in Social Sciences from Jacksonville University, where she was also on the Women's Basketball team. She now has a successful clothing company that specializes in organic baby clothes and other items. Take a look at their most popular fall fashions on bossbabymav.com
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