HIV in Canada: A primer for service providers

 

Cure Research

Key Points

  • The cure of the “Berlin patient” spurred interest in HIV cure research.
  • It will be many years before a practical cure is found.

In 2008, doctors in Berlin announced that they appeared to have cured an HIV-positive man, who was suffering from leukemia, of both cancer and HIV. The “Berlin patient” received chemotherapy, radiation and other therapies to suppress his immune system, and transplants of stem cells. The stem cells that were transplanted were chosen because they had a rare mutation that made the cells somewhat resistant to HIV infection. The stem cells took hold in his bone marrow, helping to create his new immune system. Since all of these extensive interventions, doctors have been unable to detect HIV in his body.

Researchers are divided about why the Berlin patient was cured but this case has led to clinical trials to assess different methods for attempting to cure HIV infection. The protocol used on the Berlin patient is quite dangerous and similar attempts have failed.

By using a milder regimen than the Berlin patient, stem cell transplants from other donors with this mutation were also given to patients from Dusseldorf and London (a.k.a. the “Dusseldorf patient” and “London patient”) in 2013 and 2016 respectively. These two people are in what scientists call remission: HIV cannot be detected in their body and it will take years of additional monitoring and testing before they can be declared cured. In all three people, the mutation arising from the stem cell transplant does not appear to have caused any harm.

There have been several cases of remission in children. In 2017, a case was reported of a nine-year-old child in South Africa who has been in remission for over eight years. The child was diagnosed with HIV at one month old and treated with antiretroviral drugs for 40 weeks, and then treatment was stopped as part of a clinical trial. The viral load has been undetectable (less than 20 copies /ml) since treatment stopped. In 2015, the case of an 18-year-old French girl was reported who has been in remission for 12 years with no detectable HIV viral load in her blood. She was started on antiretroviral treatment the day she was born, which was continued until she was almost six when her parents stopped treatment. She has been closely monitored and has had no viral rebound.There was an earlier case of a baby who was treated with antiretroviral drugs shortly after infection (the “Mississippi baby”). When treatment was stopped, the virus was undetectable for up to 27 months before becoming detectable again. These promising case reports of children in remission are rare.

There are cure studies being planned and in progress, including gene therapies and unusual combinations of drugs. Such studies will be complex and in some cases, perhaps dangerous. Cure research is moving ahead but this is extremely difficult research. There is unlikely to be a simple, safe and widely available cure in the next decade.

Resources

Cure Research

HIV Cure ResearchTreatmentUpdate 232

HIV Cure ResearchTreatmentUpdate 231

The search for a cureTreatmentUpdate 219

HIV Cure ResearchTreatmentUpdate 196

Canadian HIV Cure Enterprise (CanCURE)

The road towards an HIV cure – CanCURE

Sources

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