HIV in Canada: A primer for service providers

 

Cure Research

Key Points

  • The apparent cure of the “Berlin patient” spurred interest in cure research.
  • There have been case reports of children who were treated from birth with antiretroviral treatment being in remission (ongoing undetectable viral load) after treatment was stopped.
  • It will be many years before a potential cure may be 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. This means the patient has either no HIV or levels of HIV too low for the tests to detect.

Researchers are divided about why the Berlin patient was apparently 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.

There have been two reports of cases where there was temporary drug-free control of HIV in the blood in adults who had bone marrow transplants as part of attempts to cure HIV infection. However, in both these cases, HIV was detected again in the blood after a period of it being undetectable and the patients had to resume HIV treatment.

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. This is only the second confirmed case of a person with continued remission after treatment was 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.

There are many cure studies being proposed, 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

The search for a cureTreatmentUpdate 219

HIV Cure ResearchTreatmentUpdate 196

Canadian HIV Cure Enterprise (CanCURE)

The road towards an HIV cure – CanCURE

 

Sources

  1. Hütter G, Nowak D, Mossner M, et al. Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. New England Journal of Medicine. 2009 Feb 12;360(7):692–698. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa0802905
  2. Violari A, Cotton M, Kuhn L, et al. Viral and host characteristics of a child with perinatal HIV-1 following a prolonged period after ART cessation in the CHER trial. In: Program and abstracts of the 9th International AIDS Society Conference on HIV Science, Paris, July 2017. Abstract TUPDB0106LB. Available from: http://programme.ias2017.org/Abstract/Abstract/5836
  3. Frange P, Faye A, Avettand-Fenoël V, et al. HIV-1 virological remission lasting more than 12 years after interruption of early antiretroviral therapy in a perinatally infected teenager enrolled in the French ANRS EPF-CO10 paediatric cohort: a case report. Lancet HIV. 2016 Jan;3(1):e49–e54. Available from: http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(15)00232-5/fulltext
  4. Luzuriaga K, Gay H, Ziemniak  C, et al. Viremic relapse after HIV-1 remission in a perinatally infected child. New England Journal of Medicine. 2015 Feb 19;372:786­–788. Available from: http://www.nejm.org/doi/full/10.1056/NEJMc1413931