When Will The First Australian Be Cured of HIV?
At the 7th International AIDS Society Conference On HIV Pathogenesis Treatment and Prevention, Dr Timothy Henrich reported on the progress of two ‘Boston patients’ who were treated for blood cancer lymphoma (one about three years ago and the other five years ago). Both men received chemotherapy and stem-cell transplants, and now after ceasing antiretroviral medication to suppress HIV, so far have no trace of HIV in their blood, for a period of fifteen and seven weeks respectively.
If you add together the ‘Berlin Patient’, the ‘Mississippi baby’ and the two ‘Boston Patients’, the world of HIV is now tracking the progress of four patients that have potentially been cured of HIV. The knowledge gained from these very rare and unique cases is driving hope and optimism that a cure for all is fast approaching.
Many in the medical profession are keen to moderate community expectations. Knowing that clinical trials and the potential scale up of a cure could easily be five, ten or more years away. In reality no one can give a definitive answer as to when a HIV cure for all will arrive, if ever. However, as the number of potentially cured individuals grows so will most likely the speculation. Many in the HIV sector are now using the term ‘HIV remission’ instead of cure as a more accurate way of describing the results being observed. This early on, in cure research, has doctors unwilling to as yet guarantee that HIV has been eradicated from every cell in the body, for all time.
Unlike the ‘Berlin Patient’ (Timothy Brown), the hype following the ‘Boston patients’ can be justified with two key different points. According to Dr Henrick they undertook “gentler chemotherapy (reduced intensity conditioning ), and the stem-cell transplantation received was not from a donor who had naturally resistant immune cells to HIV, which is rare (less than 1% of the population). This means that a potential HIV cure has just become safer (i.e. less chemo) and more widely applicable to everyone (i.e. easier to find compatible donors). Watching the HIV cure space evolve is like observing Moore’s law, where computing hardware capacity doubles every two years, that maybe my personal optimism creeping in, pardon the indulgence.
One hypothesis proposed by Dr Henrich as to why the ‘gentler chemotherapy’ and easier to find donor for stem-cell transplantation worked included the possibility that the donor immune cells were sufficiently different from that of the host immune cells. Leading to the donor immune cells to bump out and eliminate the hosts immune cells where HIV was resting/hiding. To confirm the true reason for HIV eradication will require further research and willingness by patients to place their health and their lives on the line.
The Star Tribune reported on Eric Blue a boy aged 12, who was born with HIV. On April 23rd he received an experimental treatment at the University of Minnesota for HIV and Leukaemia. Eric Blue died July 5th. The donor providing the stem cells was not only compatible but also had the advantage of immune cells genetically resistant to HIV. His treatment pathway was closely aligned to that of the successfully cured ‘Berlin patient’. The testing on Eric Blue, while not yet conclusive revealed that he had cleared HIV and the leukaemia. According to Dr. Michael Verneris, “This patient absolutely needed to have this transplant”. In June, Eric Blue developed graft-versus-host disease, a complication from stem-cell transplantation where the donor immune cells attack various tissues of the body. While the disease can be treated “…he had an especially bad form of it” said Dr. Verneris.
It seems cruel that any young person would have to endure HIV from birth, develop leukaemia, become free of both and then die weeks later. It is important to acknowledge the pioneering medical contribution of Eric Blue. The history of HIV is full of dignified men and women who have been prepared to participate in medical experimentation for the benefit of the greater good. Most of us stand in admiration and gratefulness for their efforts.
The mortality risk associated with chemotherapy and stem-cell transplant can be as high 20%. Individual circumstances like age, disease progression and chemotherapy intensity amongst others can vary the risk. There is no getting away from the notion that for some people living with HIV, taking a pill once a day is preferable to the 20% risk of death. Even so many others are very willing and prepared to risk their health in order for modern medicine to make further advancements.
Some doctors too, must be prepared to step out of their standard treatment guidelines and be prepared to explore options for improvements in HIV treatments and prevention. Innovation is rarely riskless. Which doctors and patients (who HIV and cancer) in Australia are prepared to take on the brave challenge?
The International AIDS Society conference comes to Melbourne in July 2014. Progress on all four potentially cured patients will most likely be widely sought after and broadcast. How wonderful would it be if soon Australia could lay claim to our own HIV cured person. To the courageous people, like Eric Blue, who accept the risks and nevertheless embark on the journey to advance human medical science endeavours, we deeply thank you.
Cipriano Martinez
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