Before taking this course on HIV in South Africa, I really did not know much about HIV and the history behind it. However, with the course drawing to an end, I look back and realize how much I have learned in such a small amount of time. I am much more informed about the virus, and feel more drawn to delving into news stories related to HIV.
In particular, a recent news story that was widely publicized and caught my attention involves the two patients from Boston’s Brigham and Women’s Hospital who were both HIV-positive for thirty years and received bone marrow stem cell transplants to treat their lymphoma. After the bone marrow transplants, one patient has not had detectible HIV for two years, and the other for four years. Recently both patients have stopped taking ART, and as of now, have been HIV-free. Specifically, one has not been taking ART for fifteen weeks and the other for seven weeks. This is not the first time that stories like these have happened; in a similar light the “Berlin Patient,” Timothy Brown, was “…the first person to be cured of HIV after receiving a bone marrow transplant for leukemia in 2007.” However, there is a key difference between the Boston patients and Mr. Brown. Unlike the Berlin Patient, they did not receive stem cells with the rare genetic mutation, CCR5, which makes a person “…virtually resistant to HIV.” Instead, according to Donald G. McNeil of The New York Times, the Boston patients’ transplanted cells attacked their chemotherapy-weekend bone marrow cells, suggesting that the rare gene is not necessary to potentially eradicate HIV.
|Researcher working on stem cell transplants|
News like this is exciting because it adds to the number of patients who are potentially cured from HIV and opens up another avenue for research on HIV treatment. However, Dr. Henrich stated at an AIDS Society Conference in Kuala Lumpur that, “it is too early to say for sure that the virus has disappeared from their bodies altogether.” Bone marrow is a major area for HIV to be found, and the transplant most likely “…attacked the remaining bone marrow, which was harboring the virus,” but the article elaborated that HIV can be “hiding” in the gastrointestinal track or brain tissue.
So, what does all this implicate for the months ahead? First off, if the virus resurfaces, then the brain tissue and gastrointestinal track could also be areas where the virus can be found and that, “…new approaches to measuring the reservoir at relevant sites will be needed to guide the development of HIV curative strategies.” If this occurs, perhaps future research for HIV may focus on detecting sites where the virus can be found and more ways to identify the virus sooner. Secondly, it was also mentioned by Dr. Henrich that, “We have not demonstrated cure, we’re going to need longer follow-up. What we can say is if the virus does stay away for a year or even two years after we stopped the treatment, that the chances of the virus rebounding are going to be extremely low.” If this scenario occurs, what will be the cut-off time to declaring that patients are HIV-free? Also, can there ever be a set, uniform standard where patients can be deemed HIV-free, or will there always be an uncertainty that the virus can come back? Lastly, even if the Boston patients are found to still remain void of the virus after two years, I do not think that their treatments will be applicable for the population at large. Because stem cell therapy is so expensive, its practicality to be used worldwide for the 34 million infected is slim. But regardless of practicality, their transplants can have future implications on researching gene therapy as a possible cure for HIV.
In the months ahead, I am excited to see how much of an impact these two patients will have on the future of HIV research, prevention, and treatment and hear about the discoveries from this treatment over the long run.
*Information was gathered from the following resources:
1. “Bone marrow stem-cell therapy appears to have eradicated HIV in two patients.” 4/7/2013. <http://www.abc.net.au/news/2013-07-04/stem-cell-therapy-wipes-out-hiv-in-two-patients/4798396>.
2. Gallagher, James. “Bone marrow ‘frees men of HIV drugs.’” <http://www.bbc.co.uk/news/health-23132561