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Towards a cure for HIV

For the longest time, I have been of the opinion that a vaccine for HIV would precede a cure.

However, as it turns out, I am forced to change by stance completely.

Results of HIV Vaccine trials have been nothing short of dismal. In fact, in the latest trial, more people who received the vaccine got infected with HIV compared to the people who did not receive the vaccine! Talk about a trial gone wrong.

The evidence for a possible cure however has been stacking up.  There were 4 big events that caught everyone’s attention. We shall discuss them briefly here.

The Berlin Patient

The first event involved a patient known rather famously now as the Berlin Patient.  This patient was HIV positive and also had a form of blood cancer. He received a bone marrow transplant from a donor who had a genetic mutation that made him resistant to HIV infections. After receiving the bone marrow transplant, the Berlin patient was found to have no trace of HIV in his body even though he stopped all this HIV medications. Effectively, he was cured of HIV.

The VISCONTI Cohort

The second event is the study of 14 individuals with HIV known collectively as the VISCONTI cohort. These patients were given ARV therapy within 10 weeks of being infected with HIV. This is much earlier compared to the current recommendations of allowing the CD4 cell levels to fall to 500 or less which can take years. They remained on treatment for 3 years then stopped. Even after 6 years of stopping treatment, they were found to have normal CD4 cell levels and extremely low levels of HIV virus in their blood. Although not a full cure, this is known as a functional cure. In other words, without medication, the disease was not progressing. In other words, they could possibly lead the rest of their lives normally without having to take any ARV therapy.

The Mississippi Baby

The third event involved a little infant known now as the Mississippi Baby. This baby was born to a HIV positive mother and instead of waiting for weeks to confirm that the baby has been infected with HIV, the treating doctor took a heroic step and started the baby on ARV therapy almost immediately after birth. The baby was then lost to follow up (i.e. the mother did not bother to bring her back to take her medicines). However, as luck would have it, when the baby did finally get to see her doctor again, they found that she had a normal CD4 cell count and a very low viral load. This is another case of a functional cure.

Update July 2014: After being off anti-HIV drugs for 27 months, The Mississippi Baby relapsed. The HIV virus is once again detectable in her system.

The forth and last event was recently reported at this year’s International AIDS Society conference. 2 HIV positive men were treated for Lymphoma (a type of blood cancer) in Boston. They received stem cell transplants much like the Berlin patient. However, one important difference is that they received stem cells from donors not known to have the mutation that renders them resistant to HIV. Since the treatment, one of the patients has been off his ARV medicines for 7 weeks and the other for 15 weeks. Both still do not have any HIV virus detectable in their systems.

Many of you reading this might be thinking ‘Hey! That’s it! That’s the cure for HIV! Bone marrow transplants! WooHoo!!’ Well, best you hold your horses there a little partner.  Remember that the mortality rate for bone marrow transplants can reach 20%. That’s right. I am saying 1 in every 5 people who try this treatment actually die from it. That is a rather big risk to take considering HIV positive patients now can lead long productive lives on ARV.

This however does open up many areas of research and it also has caught the world’s attention. A HIV cure is possible. Hopefully this will galvanise scientists, medical professionals, politicians and philanthropists towards a common goal of finally finding a cure for HIV.

 

advise


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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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7 Comments

  1. Samir Hussain

    Dear Sir,
    My question is it possible hiv cmia repeatedly reactive but antibody to hiv(elisa,w.blot) negative more than 9 months?

    • Yes it is. As with all tests, there is always a chance of false positive results. Different tests detect different antigens. It can be so coincidental that your body contains a particular protein that looks a lot like one of the antigens the CMIA tests for and hence it is always positive. The same antigen is not tested for in other tests like the ELISA so they are always negative. I have personally seen several of such cases.

      • Hi Dr. Tan

        On you website it is mentioned that the 4th gen test is conclusive at 28 days, however from current scientific data, you know that it as good as 100 % conclusive at 20 days.

        I had unprotected sex with an ex-gf and took the 4th gen combo test exactly 22 days after exposure. Is that conclusive?

        • forgot to mention the result came back negative and she was tested in the past year

        • I agree with you that current scientific data shows that the 4th Gen HIV test is as good as conclusive at 20 days. However, official guidelines still say that the window period is 28 days and that is what we have to tell you. So I cannot say that your ex-gf’s test is conclusive at 22 days.

  2. Hi Dr. What is the cost for ARV therapy.

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